Accuracy of an adherence score and time in therapeutic range among patients on chronic use of vitamin K antagonists
DOI:
https://doi.org/10.33448/rsd-v10i8.16523Keywords:
Anticoagulants; Cardiovascular diseases; Medication adherence; Validation studies; Nursing.Abstract
To validate and analyze the accuracy of the Simonetti adherence score among patients on chronic use of vitamin K antagonists and their time in therapeutic range (TTR) of the international normalized ratio as a measure of quality of anticoagulation. A prospective cohort study with a nonrandomized intervention in patients from an anticoagulation center of a public hospital. Baseline data were collected from May to September 2017, and follow-up data were obtained eight months after a nurse-led educational intervention, which was given to all patients after consent form and after applying the adherence score (N=205). The intervention was undertaken through 30-40 min conversation about relevant factors that had been previously identified in the score derivation study, which comprised drug-drug interactions, inadequate OAC use, comorbidities, effects of food on vitamin K absorption, and invasive procedures. A receiver operating characteristic (ROC) curve was applied to validate the adherence score in terms of prediction of INR out of recommended therapeutic range. At baseline, mean adherence score was 44.69 and standard deviation (SD) was 18.37, and mean TTR was 41.07 (SD 15.40). Patients were reassessed after 8 months. At follow-up, there were significant improvements in mean adherence score 54.28 (SD 13.13), and in mean TTR 50.99 (SD 26.10). The Simonetti adherence score yielded high performance and accuracy in clinical practice among patients on chronic use of vitamin K antagonists. Our data indicate that nurse led educational intervention yielded favorable impact in terms of adherence score and TTR improvements.
References
Agnelo, P., Alexandra, D., & Matias, S. (2014) Primary care monitoring of patients under oral anticoagulation. Portuguese Journal of Cardiology 33(7-8), 397-401, 10.1016/j.repce.2013.12.004
Cabellos-García, A., C., Martínez-Sabater, A., Castro-Sánchez, E., Kangasniemi, M., Juárez-Vela, R., & Gea-Caballero, V. (2018) Relation between health literacy, self-care and adherence to treatment with oral anticoagulants in adults: a narrative systematic review. BMC Public Health 18(1157), 2-12, 10.1186/s12889-018-6070-9
Coelho, A. C., Lucas, D. M. S., Nunes, G. K., Neves MP., Silva LA., Tonini T & Silva RFA. (2021) Criação de personagens lúdicas para capacitação em serviço da equipe de Enfermagem sobre anticoagulants orais. Research, Society and Development 10(3), e27110313250, http://dx.doi.org/10.33448/rsd-v10i3.13250
Colet, C. F., Amador, T. A. & Heineck, I. (2017) Therapeutic monitoring of patients using varfarin: a review of the literature. Journal Context and Health 17(32), 134-143, 10.21527/2176-7114.2017.32.134-143
Colet, C. F., Holzle, de M., Seidler, R. E., Boff, E. T. de O., Amador, T. A. & Heineck, I. (2016) Health professionals’ knowledge on the use of warfarin in hospital settings. Journal of the Brazilian Society of Internal Medicine 14(4), 204-211.
Costa, J. M., Pimento, M. C., Groia, R. C. S., Costa, M. A., Antunes, M. I. S. S., & Martins, M. A. P. (2016) Time in Therapeutic range in patients using oral anticoagulant therapy. Brazilian Journal of Hospital Pharmacy and Health Services 7(1), 13-16.
Edelmuth, S. V. C. L., Sorio, G. N., Sprovieri, F. A. A., Gali, J. C., & Peron, S. F. (2018) Comorbidities, clinical intercurrences, and factors associated with mortality in elderly patients admitted for a hip fracture. Brazilian Journal of Orthopedics 53(5), 543-551, 10.1016/j.rboe.2018.07.014
Figueirêdo, T. R., Costa, C. R. B., Silveira, M. M. B. M., Araújo, H. V. S., Silva, T., & Bezerra, S. M. M. S. (2018) Pharmacological adherence and knowledge of anticoagulated patients. Avances en Enfermería 36(2), 143-152,
Groia, R. C. S., Costa, J. M., Santos, T. O., Lopes, L. M., Martins, J. M., Pedroso, L. A., Martins, M. A. P., & Reis, A. M. M. (2015) Strategies for promoting medication adherence in an outpatient anticoagulation: a contribution to the effectiveness of treatment. Brazilian Journal of Pharmacy 96(2), 1160-1177.
January, C. T., Wann, L. S., Calkins, H., Chen, L. Y., Cigarroa, J. E., ClevelandJr, J. C., Elinor, P. T., Ezekowitz, M. D., Field, M. E., Furie, K. L., Heidenreich, P. A., Murray, K. T., Shea, J. B., Tracy, C. M., & Yancy, C. W. (2014) AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 139,10-16, 10.1161/CIR.0000000000000665
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H. C., Heidbuchel, H., Hendriks, J., Hindricks, G., Manolis, A. S., Oldgren, J., Popescu, B. A., Schotten, U., Putte, B. V., & Vardas, P. (EHRA) (2016) ESC Guidelines for the Management of Atrial Fibrillation developed in collaboration with EACTS. European Heart Journal 37(38), 2893-2962, 10.1093/eurheartj/ehw210
Magalhães, L. P., Figueiredo, M. J.O., Cintra, F. D., Saad, E. B., Kuniyishi, R. R., Teixeira, R. A., Lorga Filho, A. M., D’Avila, A., de Paola, A. A. V., Kalil C. A., Moreira, D. A. R., Sobral Filho, D. C., Sternick, E. B., Darrieux, F. C. C., Fenelon, G., Lima, G. G., Atié, J., Mateos, J. C. P., Moreira, J. M., Vasconcelos, J. T. M., Zimerman, L. I., Silva, L. R. L., Silva, M. A., Scanavacca, M. I., & Souza, O. F. (2016) II Brazilian Guidelines for Atrial Fibrillation. Brazilian Archives of Cardiology 106(4Supll.2),1-22.
Mandrola, J. (2016) AHA 2016: How do NOAC drugs fare against well-managed Warfarin? Medscape. 2016, https://www.medscape.com/viewarticle/871920
Marin, M. J. S., et al. (2013) Knowing the reasons for nonadherence to health educacional actions. REME (Online) 17(3), 500-504, 10.5935/1415-2762.20130037
Neto Almeida, O. P., et al (2016) Clinical profile, adherence, and therapy satisfaction of patients in use of oral anticoagulants. Journal of Health Care 14(47), 61-66.
Pelegrino, F. M., et al. (2014) Educational protocol for patients on oral anticoagulant therapy: construction and validation. Text & Context Nursing 23(3), 799–806, 10.1590/0104-07072014001440013
Pereira, A S., et al. (2018). Metodologia da pesquisa cientifica. UFSM. https://repositorio.ufsm.br/bitstream/handle/1/158 24/Lic_Computac ao_Metodologia-Pesquisa-Cientifica.pdf?sequence=1.
Shiffman, M., & Low, M. (2020) Vascular Surgery, Neurosurgery, Lower Extremity Ulcers, Antimicrobials, Wound Assessment, Care, Measurement and Repair. Springer International Publishing. 10.1007/978-3-030-10716-1.
Simonetti, S. H., et al. (2019) Clinical predictors involved in adhesion of oral anticoagulant users. Nursing in focus 10(1), 02-06.
Simonetti, S. H., et al. (2014) Adherence to therapy with oral anticoagulants: an integrative review. Journal of Nursing UFPE On Line 8(8), 2854-2863,
Simonetti, S. H., et al. (2018) Adherence score for users of oral anticoagulants. International Journal of Cardiovascular Sciences 31(4), 383–392.
Simonetti, S. H., et al. (2018) Conventional and innovative educational method for oral anticoagulation user learning. Nursing in focus 8(4), 03-06.
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Copyright (c) 2021 Sérgio Henrique Simonetti; Gustavo Bernardes de Figueiredo Oliveira; Fabiana Cristina Lourenço; França João Ítalo Dias
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