Gediminas Urbonas, Viltė Medzevičiūtė, Saulius Andruškevičius
The aim: to determine the dependency of warfarin therapy efficiency among patients with chronic atrial fibrillation (AF) on the distance to medical institution, also to compare warfarin therapy efficiency and the distance to medical institution in different gender or age groups and evaluate relations between warfarin therapy efficiency and the distance to medical institution between urban and rural residents. Methodology. Cross-section study was carried out. The study analysed outpatient charts who were diagnosed with chronic AF, using warfarin and coming to family physician to do INR tests. Results. 406 cases have been analysed, age average is 75 yrs. (± 9 yrs). TTR average is 42.1 % (± 24.69 %). Allocation by TTR: TTR ≥ 70 % – 16.3 %; TTR 30 – 70 % – 52.5 %; TTR < 30 % – 31.3 % of the subjects. Allocation by distance to medical institution: < 3 km – 61.4 %, ≥ 3 km – 38.6 %. Therapy effectiveness is not significantly differ between patients residing < 3 km and ≥ 3 km to medical institution; p = 0.914. Pearson correlation coefficient implies that as the distance to medical institution increases, TTR tends to decrease in men’s group; the difference is not statistically significant (r = -0.13; p = 0.08). Therapy effectiveness for the < 65 yrs. age group is statistically significantly different between subjects residing < 3 km and ≥ 3 km (p < 0.05). In the age group of < 65 yrs., for 30.8 % of patients residing < 3 km and for 7.4 % residing ≥ 3 km to medical institution TTR is ≥ 70 %. Average TTR for urban residents – 39.4 %, 42.9 % for rural; the difference is not statistically significant (p = 0.222). Conclusions. Relation between effectiveness of warfarin therapy and distance to medical institution is not detected. Men’s group showed a tendency that with increase of the distance to the medical institution, TTR decreases. Statistically significant difference is not detected. Effectiveness of treatment significantly differed in the age group of < 65 yrs. between residing < 3 km and ≥ 3 km; For those residing < 3 km INR was more often in therapeutic range. No relations between effectiveness of treatment and patient’s place of residency is found.
Keyword(s): atrial fibrillation; warfarin; TTR; family physician.
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