Improving the quality of anticoagulation of patients with atrial fibrillation in managed care organizations: results of the managing anticoagulation services trial
Abstract
Randomized trials have indicated that well-managed anticoagulation with warfarin could prevent more than half of the strokes related to atrial fibrillation. However, many patients with atrial fibrillation who are eligible for this therapy either do not receive it or are not maintained within an optimal prothrombin time-international normalized ratio (INR) range. We sought to determine whether an anticoagulation service within a managed care organization would be a feasible alternative for providing anticoagulation care. We performed a multi-site randomized trial in six large managed care organizations in the United States. Subjects were aged 65 years or older and had nonvalvular atrial fibrillation. At each site, physician practices were divided into two geographically defined practice clusters; each site was randomly assigned to have one intervention and one control cluster. The intervention cluster received an anticoagulation service that satisfied specifications for high-quality anticoagulation care and was coordinated through the managed care organization. Control clusters continued with their usual provider-based care. We measured the proportion of time that warfarin-treated patients in each of the clusters (intervention and control) were in the target range for the INR at baseline, and again during a follow-up period. Five of the six selected sites succeeded at developing an anticoagulation service. Patients in the intervention and control clusters had similar demographic characteristics, contraindications to warfarin, and risk factors for stroke. Among patients (n = 144 in the intervention clusters; n = 118 in the control clusters) for whom data were available during the baseline and follow-up periods, the changes in percentages of time in the target range were similar for those in the intervention clusters (baseline: 47.7%; follow-up: 55.6%) and in the control clusters (baseline: 49.1%; follow-up: 52.3%; intervention effect: 5%; 95% confidence interval: -5% to 14%; P = 0.32). Although it was feasible in a managed care organization to implement anticoagulation services that were tailored to local circumstances, provision of this service did not improve anticoagulation care compared with usual care. The effect of the anticoagulation service was limited by the utilization of the service, the degree to which the referring physician supports strict adherence to recommended target ranges for the INR, and the ability of the anticoagulation service to identify and to respond to out-of-range values promptly.
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In Matchar 2002, other bias was at unclear risk of bias.
“Other bias Unclear risk Contamination may have been possible, since geographically related practices were randomised to intervention and control groups. Patient characteristics were similar in both groups”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Matchar 2002
In Matchar 2002, selective reporting was at low risk of bias.
“Selective reporting (reporting bias) Low risk Appropriate outcomes reported”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Matchar 2002
In Matchar 2002, overall risk of bias was high.
“Risk of bias overall High risk 5 unclear risk criteria, including allocation concealment”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Matchar 2002
In Matchar 2002, random sequence generation was at low risk of bias.
“Random sequence generation (selection bias) Low risk A computer random number function was used”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Matchar 2002
In Matchar 2002, allocation concealment was at unclear risk of bias.
“Allocation concealment (selection bias) Unclear risk Process not reported”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Matchar 2002
In Matchar 2002, blinding of outcome assessment was at unclear risk of bias.
“Blinding of outcome assessment (detection bias) All outcomes Unclear risk Whether or not the data abstractors were blinded is not reported”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Matchar 2002
In Matchar 2002, baseline characteristics were at unclear risk of bias.
“Baseline characteristics Unclear risk There were no differences in patient characteristics between study groups. No data on clinicians”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Matchar 2002
In Matchar 2002, contamination was at low risk of bias.
“Contamination Low risk Groups of geographically related practices were randomised”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Matchar 2002
In Matchar 2002, baseline outcomes were at low risk of bias.
“Baseline outcomes Low risk No differences at baseline”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Matchar 2002
In Matchar 2002, incomplete outcome data was at high risk of bias.
“Incomplete outcome data (attrition bias) All outcomes High risk 30% attrition is reported”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Matchar 2002
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“shown to reduce the number of bleedings as well [24, 25].”
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Nichol, M. B., Knight, T. K., Dow, T., Wygant, G. D., Borok, G. M., Hauch, O., & O’Connor, R. D. (2007) · Annals of Pharmacotherapy · doi:10.1345/aph.1k157 · Cited by 59 · see citing works
The impact of pharmacist-managed oral anticoagulation therapy in older veterans
Poon, I. O., Lal, L. S., Brown, E. N., & Braun, U. K. (2007) · Journal of Clinical Pharmacy and Therapeutics · doi:10.1111/j.1365-2710.2007.00792.x · Cited by 57 · see citing works
“To further investigate the effect of pharmacist-monitored anticoagulation outcomes, we reviewed the number of INR values £1Æ5, 4–9, >9 and calculated mean elapsed time between INR values £1Æ5, between 4 and 9, and >9 and the next INR value in days to assess the timeliness of response to non-therapeutic INR values (19,…”
MethodIndividualizing Warfarin Therapy
Reynolds, K. K., Valdes, R., Ramey-Hartung, B., & Linder, M. W. (2007) · Personalized Medicine · doi:10.2217/17410541.4.1.11 · Cited by 57 · see citing works
Randomized Trial of a Warfarin Communication Protocol for Nursing Homes: an SBAR-based Approach
Field, T. S., Tjia, J., Mazor, K. M., Donovan, J. L., Kanaan, A. O., Harrold, L. R., Reed, G. W., Doherty, P., Spenard, A., & Gurwitz, J. H. (2011) · The American Journal of Medicine · doi:10.1016/j.amjmed.2010.09.017 · Cited by 57 · see citing works
Darkow, T., Vanderplas, A. M., Lew, K. H., Kim, J., & Hauch, O. (2005) · Current Medical Research and Opinion · doi:10.1185/030079905x61956 · Cited by 57 · see citing works
Harrison, J., Shaw, J., & Harrison, J. (2014) · International Journal of Pharmacy Practice · doi:10.1111/ijpp.12148 · Cited by 55 · see citing works
Ogawa, S., Koretsune, Y., Yasaka, M., Aizawa, Y., Atarashi, H., Inoue, H., Kamakura, S., Kumagai, K., Mitamura, H., Okumura, K., et al. (2011) · Circulation Journal · doi:10.1253/circj.cj-11-0304 · Cited by 55 · see citing works
Verhovsek, M. M., Motlagh, B., Crowther, M. A., Kennedy, C. C., Dolovich, L. R., Campbell, G., Wang, L., & Παπαϊωάννου, Α. (2008) · BMC Geriatrics · doi:10.1186/1471-2318-8-13 · Cited by 51 · see citing works
“0 for these common indications [6-8], maintenance of therapeutic INR in the community is generally poor [9-11].”
BackgroundMeasuring Quality of Oral Anticoagulation Care: Extending Quality Measurement to a New Field
Rose, A. J., Berlowitz, D. R., Frayne, S. M., & Hylek, E. M. (2009) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/s1553-7250(09)35019-9 · Cited by 51 · see citing works
The Increasing Need for Anticoagulant Therapy to Prevent Stroke in Patients With Atrial Fibrillation
Ezekowitz, M. D., & Falk, R. H. (2004) · Mayo Clinic Proceedings · doi:10.4065/79.7.904 · Cited by 50 · see citing works
Monitoring anticoagulation in atrial fibrillation
Sarawate, C. A., Sikirica, M. V., Willey, V. J., Bullano, M. F., & Hauch, O. (2006) · Journal of Thrombosis and Thrombolysis · doi:10.1007/s11239-006-4968-z · Cited by 42 · see citing works
“Further, even in studies with more general clinical settings, and a population more similar to this one in terms of age and stroke risk factors, anticoagulation services may not be totally effective [28].”
BackgroundResultZhao, S., Zhao, H., Wang, X., Gao, C., Qin, Y., Cai, H., Chen, B., & Cao, J. (2017) · Patient Preference and Adherence · doi:10.2147/ppa.s120962 · Cited by 40 · see citing works
The quality of oral anticoagulation in general practice in patients with atrial fibrillation
Mueller, S., Pfannkuche, M., BREITHARDT, G. E., Bauersachs, R. M., Maywald, U., Kohlmann, T., & Wilke, T. (2014) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2013.12.013 · Cited by 35 · see citing works
“The data generated by the questionnaires addressed to the patients were used to calculate the following five scores: (1) HrQoL (EQ5-D score [25] and SF-36 sum scales [26]); (2) EHRA symptoms (severity from 0 to 3 multiplied with frequency from 1 to 3); (3) a non-adherence score [36] with a scale from 10 to 40 (higher…”
MethodThe Future of Anticoagulation Clinics
Macik, B. G. (2003) · Journal of Thrombosis and Thrombolysis · doi:10.1023/b:thro.0000014594.52685.33 · Cited by 32 · see citing works
Matchar, D. B., Jacobson, A. K., Edson, R., Lavori, P. W., Ansell, J., Ezekowitz, M. D., Rickles, F. R., Fiore, L., Boardman, K., Phibbs, C. S., et al. (2005) · Journal of Thrombosis and Thrombolysis · doi:10.1007/s11239-005-1452-0 · Cited by 32 · see citing works
“Despite the compelling evidence supporting the value of AC and the importance of high quality AC, warfarin remains underused and, for those receiving treatment, dosing is often suboptimal [2].”
BackgroundMethodInfluentialSelf-citationRole of the anticoagulant monitoring service in 2018: beyond warfarin
Clark, N. P. (2018) · Hematology · doi:10.1182/asheducation-2018.1.348 · Cited by 31 · see citing works
Zhu, Z., Li, C., Shen, J., Wu, K., Li, Y., Liu, K., Zhang, F., Zhang, Z., Li, Y., Han, J., et al. (2021) · Journal of Medical Internet Research · doi:10.2196/29529 · Cited by 29 · see citing works
“The conventional way to manage anticoagulation is face to face [12], but the quality of this approach depends highly on the patients’ compliance, resulting in difficulty in management and increased risk of adverse events [13,14].”
BackgroundDrug therapy in the elderly: Improving quality and access
Simon, S. R., & Gurwitz, J. H. (2003) · Clinical Pharmacology & Therapeutics · doi:10.1016/s0009-9236(03)00011-0 · Cited by 29 · see citing works
“promise for improving the quality of anticoagulation care, it is important to note that a recent randomized, controlled trial failed to show that these specialized clinics improved the processes and outcomes of care for patients requiring anticoagulation.(67) Conversely, randomized, controlled trials have demonstrated…”
BackgroundPatterns of warfarin use and subsequent outcomes in atrial fibrillation in primary care practices
Ewen, E. F., Simon, 。., Weintraub, Kolm, P., Zhang, Z., & Liu, X. (2012) · Vascular Health and Risk Management · doi:10.2147/vhrm.s34280 · Cited by 27 · see citing works
Tendera, M., Syzdół, M., & Parma, Z. (2012) · Cardiology Journal · doi:10.5603/cj.2012.0002 · Cited by 25 · see citing works
“Data from clinical trials show that patients with AF achieve the therapeutic INR range only during 60% of treatment time [8].”
MethodMatchar, D. B., Love, S. R., Jacobson, A. K., Edson, R., Uyeda, L., Phibbs, C. S., & Dolor, R. J. (2014) · Journal of Thrombosis and Thrombolysis · doi:10.1007/s11239-014-1128-8 · Cited by 22 · see citing works
“HQACM was defined as care that met the following criteria based on the deliberations of an expert panel [18]: a designated, trained staff responsible for patients’ visits and follow-up; the use of a standard, local procedure at each site for AC management; and the performance of regular INR testing approximately once…”
MethodSelf-citationSamsa, G. P., Matchar, D. B., Phillips, D. L., & McGrann, J. (2002) · Journal of Thrombosis and Thrombolysis · doi:10.1023/a:1023276710895 · Cited by 22 · see citing works
“For UC and ACS, the distribution of time in each INR category was obtained from a randomized trial comparing anticoagulation services to usual care [3].”
MethodSelf-citationAt-Home Versus In-Clinic INR Monitoring: A Cost–Utility Analysis from The Home INR Study (THINRS)
Phibbs, C. S., Love, S. R., Jacobson, A. K., Edson, R., Su, P., Uyeda, L., & Matchar, D. B. (2016) · Journal of General Internal Medicine · doi:10.1007/s11606-016-3700-8 · Cited by 22 · see citing works
Self-citationJACKSON, K. P., Gersh, B. J., Stockbridge, N., Fleming, T. R., Temple, R., Califf, R. M., Connolly, S. J., Wallentin, L. C., & Granger, C. B. (2008) · American Heart Journal · doi:10.1016/j.ahj.2008.01.023 · Cited by 21 · see citing works
“0 approximately 50% of the time.(23,24) Importantly, nearly two thirds of patients with AF who sustain an ischemic stroke while taking warfarin are below target range.”
BackgroundCeresetto, J. M. (2016) · Clinics · doi:10.6061/clinics/2016(01)07 · Cited by 22 · see citing works
“Real-world TTR levels are likely to be at least 10-20% lower (59).”
BackgroundLiang, J., Lao, C., Tian, L. H., Yang, Y., Wu, H.-M., Tong, H. H. Y., & Chan, A. (2019) · International Journal of Pharmacy Practice · doi:10.1111/ijpp.12584 · Cited by 20 · see citing works
“Previous literature reported that patients spent approximately 50% of TTR if their warfarin therapy were managed solely by physicians.([25,30,31]) The PEFS was estimated to enhance the TTR by about 10%.”
BackgroundBontempo, L. J., & Goralnick, E. (2011) · Emergency Medicine Clinics of North America · doi:10.1016/j.emc.2011.08.008 · Cited by 20 · see citing works
Bleeding risks associated with vitamin K antagonists
Linkins, L. (2013) · Blood Reviews · doi:10.1016/j.blre.2013.02.004 · Cited by 20 · see citing works
Patterns of anticoagulation following bioprosthetic valve implantation: observations from ANSWER.
Brennan, J. M., Alexander, K. P., Wallace, A., Hodges, A. B., Laschinger, J. C., Jones, K. W., O’Brien, S. M., Webb, L. E., Dokholyan, R. S., & Peterson, E. D. (2012) · PubMed · Cited by 19 · see citing works
Novel anticoagulants in atrial fibrillation stroke prevention
Norgard, N. B., DiNicolantonio, J. J., Topping, T. J., & Wee, B. (2012) · Therapeutic Advances in Chronic Disease · doi:10.1177/2040622312438934 · Cited by 19 · see citing works
“Maintaining a therapeutic range has proven difficult as a significant number of patients’ INRs (international normalized ratios) deviate from target range resulting in an increased risk for either thromboembolism or hemorrhage [Matchar et al. 2002; Connolly et al. 2006; Gladstone et al. 2009].”
BackgroundDirect thrombin inhibitors and factor Xa inhibitors in patients with cerebrovascular disease
Morales‐Vidal, S., Schneck, M. J., Flaster, M. S., & Biller, J. (2012) · Expert Review of Neurotherapeutics · doi:10.1586/ern.11.185 · Cited by 16 · see citing works
Bringing the Benefits of Anticoagulation Management Services to the Community
Bungard, T. J., Archer, S. L., Hamilton, P. G., Ritchie, B. C., Tymchak, W. J., & Tsuyuki, R. T. (2006) · Canadian Pharmacists Journal / Revue des Pharmaciens du Canada · doi:10.1177/171516350613900207 · Cited by 16 · see citing works
Changes in surrogate outcomes can be translated into clinical outcomes using a Monte Carlo model
van Walraven, C., Oake, N., Coyle, D., Taljaard, M., & Forster, A. J. (2009) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2009.01.015 · Cited by 15 · see citing works
Liu, S., Singer, A. G., McAlister, F. A., Peeler, W., Heran, B. S., Drummond, N., Manca, D. P., Allan, G. M., Korownyk, C. S., Kolber, M. R., et al. (2019) · PubMed Central · Cited by 13 · see citing works
Louis, K. M., Martineau, J., Rodrigues, I., Fournier, M., Berbiche, D., Blais, N., Ginsberg, J., Blais, L., Montigny, M., Perreault, S., et al. (2010) · American Heart Journal · doi:10.1016/j.ahj.2009.11.015 · Cited by 13 · see citing works
Physician compliance with outpatient oral anticoagulant guidelines in Auvergne, France
Ruivard, M., Berger, C., Achaibi, A., Campagne, C., & Philippe, P. (2003) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2003.21230.x · Cited by 13 · see citing works
Quality of life in patients with nonvalvular atrial fibrillation treated with oral anticoagulants
Gabilondo, M., Loza, J. Á., Pereda, Á., Caballero, O., Zamora, N., Gorostiza, A., & Mar, J. (2021) · Hematology · doi:10.1080/16078454.2021.1892329 · Cited by 12 · see citing works
“indicates that the quality of anticoagulation with VKAs is related to the intensity of monitoring [23,24].”
BackgroundKing, S. R., King, E., Kuhl, D. A., & Peyton, L. (2020) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2020.04.026 · Cited by 12 · see citing works
Simmons, B. J., Jenner, K. M., Delate, T., Clark, N. P., Kurz, D., & Witt, D. M. (2012) · Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy · doi:10.1002/phar.1139 · Cited by 12 · see citing works
Anticoagulation for atrial fibrillation
Fang, M. C., & Singer, D. E. (2004) · Cardiology Clinics · doi:10.1016/s0733-8651(03)00115-2 · Cited by 12 · see citing works
Willems, R., & Exner, D. V. (2004) · Journal of Interventional Cardiac Electrophysiology · doi:10.1023/b:jice.0000011340.74632.ac · Cited by 11 · see citing works
“It is clear that in order for such dedicated anticoagulation clinics to be successful there needs to be a commitment from payers and geographic stability within the population [45].”
BackgroundClinical outcomes of a pharmacist-managed anticoagulation service for breast cancer patients
Jones, K. L., Barnett, C. M., Gauthier, M., Boster, B. L., Espirito, J. L., & Michaud, L. B. (2011) · Journal of Oncology Pharmacy Practice · doi:10.1177/1078155210397775 · Cited by 11 · see citing works
“4% in the UC group.(18,19) Recurrent VTEs in our patient population are within the ranges of non-oncology patients that received AMS and UC, but lower than cancer patients receiving warfarin.”
MethodResultEggebrecht, L., Ludolph, P., Göbel, S., Panova‐Noeva, M., Arnold, N., Nagler, M., Bickel, C., Lauterbach, M., Hardt, R., Cate, H. T., et al. (2021) · Scientific Reports · doi:10.1038/s41598-021-82076-9 · Cited by 10 · see citing works
Does treatment guided by vitamin K in the diet alter the quality of life of anticoagulated patients?
de Assis, M. C. S., Cruz, L. N., Zuchinali, P., Rohde, L. E. P., & Rabelo, E. R. (2012) · PubMed · doi:10.3305/nh.2012.27.4.5847 · Cited by 9 · see citing works
Warfarin versus aspirin for stroke prevention (BAFTA)
Mihas, C. C., Alevizos, A., Arapaki, A., & Mariolis, A. D. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61679-1 · Cited by 9 · see citing works
Experiencia de una clínica de anticoagulación
Laverde, L. P., Gómez, S. E., Montenegro, A. C., Lineros, A., Wills, B., & Buitrago, A. F. (2015) · Revista Colombiana de Cardiología · doi:10.1016/j.rccar.2015.04.008 · Cited by 8 · see citing works
Keller, K., Göbel, S., ten Cate, V., Panova‐Noeva, M., Eggebrecht, L., Nagler, M., Coldewey, M., Foebel, M., Bickel, C., Lauterbach, M., et al. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9103281 · Cited by 8 · see citing works
“By contrast, other studies did not report similarly high percentages of TTR, reporting median TTR values below 70% [21,22,32].”
ResultGrogan, A., Coughlan, M., Prizeman, G., O'Connell, N. M., O’Mahony, N., Quinn, K., & McKee, G. (2017) · Journal of Clinical Nursing · doi:10.1111/jocn.13767 · Cited by 8 · see citing works
Miller, P. S. J., Drummond, M., Langkilde, L. K., McMurray, J. J. V., & Ögren, M. (2005) · European Heart Journal Supplements · doi:10.1093/eurheartj/sui019 · Cited by 7 · see citing works
A Validated LC-MS/MS Method for the Estimation of Apixaban in Human Plasma
Baig, M. L. A., & Ali, S. A. (2017) · Journal of Applied Pharmaceutical Science · doi:10.7324/japs.2017.70406 · Cited by 7 · see citing works
“: +919960883737 2011; Mueck et al., 2013; Matchar et al., 2002; Gadisseur et al., 2004; Shenker et al., 2012).”
Warfarin management after discharge from hospital: a qualitative analysis
Chalmers, L., van Tienen, E., Peterson, G. M., Bereznicki, L., Jackson, S., Bajorek, B. V., Mullan, J., & DeBoos, I. (2011) · Journal of Clinical Pharmacy and Therapeutics · doi:10.1111/j.1365-2710.2011.01308.x · Cited by 7 · see citing works
Implications for Nursing Care of Patients With Atrial Fibrillation
Kellen, J. C. (2004) · The Journal of Cardiovascular Nursing · doi:10.1097/00005082-200403000-00007 · Cited by 7 · see citing works
Improving Adherence to Treatment Guidelines
Gándara, E., Moniz, T. T., Dolan, M. L., Melia, C., Dudley, J. C., Smith, A. J., & Kachalia, A. B. (2009) · Critical Pathways in Cardiology A Journal of Evidence-Based Medicine · doi:10.1097/hpc.0b013e3181bc8074 · Cited by 7 · see citing works
Scott-Herridge, J., Seifer, C. M., Steigerwald, R., Drobot, G., & McIntyre, W. F. (2016) · Acute Cardiac Care · doi:10.1080/17482941.2017.1406954 · Cited by 6 · see citing works
“Despite strong clinical evidence of benefit, OAC use remains limited by non-prescription (<50%) (6,7), non-adherence (6) and sub-therapeutic drug levels (8,9), resulting in both high social and medical costs secondary to stroke (9), which are often more severe than strokes of other etiology (10).”
BackgroundUpdate on anti-coagulation in atrial fibrillation
Kreuzer, J. (2011) · QJM · doi:10.1093/qjmed/hcr107 · Cited by 6 · see citing works
Goralnick, E., & Bontempo, L. J. (2015) · Emergency Medicine Clinics of North America · doi:10.1016/j.emc.2015.04.008 · Cited by 6 · see citing works
Physician Attitudes Concerning Anticoagulation Services in the Long-Term Care Setting
Harrold, L. R., Gurwitz, J. H., Tate, J. P., Becker, R. C., Stuart, T. L., Elwell, A., & Radford, M. J. (2002) · Journal of Thrombosis and Thrombolysis · doi:10.1023/a:1022018422237 · Cited by 6 · see citing works
“Most recently, Matchar and colleagues performed a multi-site randomized trial examining the use of an anticoagulation service as compared to usual care in six large managed care organizations in the United States [11].”
BackgroundSafe and Effective Anticoagulation in the Outpatient Setting: A Systematic Review of the Evidence
He, B., Taylor, B. C., Krause, A., Reddy, P., Greer, N. L., MacDonald, R. H., Rutks, I. R., & Tj, W. (2011) · Cited by 6 · see citing works
Kow, C. S., Chen, F., Leong, S. K. J., Tham, K. Y., Yeoh, L., Chew, Z. M., Peh, W. J., & Thiruchelvam, K. (2025) · Expert Review of Cardiovascular Therapy · doi:10.1080/14779072.2025.2523920 · Cited by 5 · see citing works
Jain, R., Fu, A.-C., Lim, J. T., Wang, C., Elder, J., Sander, S. D., & Tan, H. (2017) · Journal of Managed Care & Specialty Pharmacy · doi:10.18553/jmcp.2018.24.1.73 · Cited by 5 · see citing works
Do specialty anticoagulation clinics really outperform primary care at INR management?
Garrison, S., & Allan, G. M. (2014) · Journal of Thrombosis and Thrombolysis · doi:10.1007/s11239-014-1113-2 · Cited by 5 · see citing works
“Another compared primary care management to that of an anticoagulation service [4].”
BackgroundPinto, S. S., Teixeira, A., Henriques, T. S., Monteiro, H. J., & Martins, C. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-040404 · Cited by 4 · see citing works
Clinical service organisation for adults with atrial fibrillation
Ferguson, C., Shaikh, F., Allida, S. M., Hendriks, J., Gallagher, C., Bajorek, B. V., Donkor, A., & Inglis, S. C. (2024) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013408.pub2 · Cited by 3 · see citing works
- Authors
- Matchar, D. B., Samsa, G. P., Cohen, S. J., Oddone, E. Z., & Jurgelski, A. E.
- Affiliations
- Duke University (US)
- University of Arizona (US)
- Corresponding author
- Matchar, David B
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 2002-07
- Volume
- 113
- Issue
- 1
- Pages
- 42-51
- ISSN
- 0002-9343 (ISSN-L)
- OpenAlex
- W2063025825
- Cited by
- 141
- References
- 48
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 2 · 2021: 5 · 2020: 3 · 2019: 3 · 2018: 2 · 2017: 7 · 2016: 4 · 2015: 7 · 2014: 10 · 2013: 7 · 2012: 13
- FWCI
- 5.89
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Keywords
- atrial fibrillation, anticoagulation management, warfarin, INR control, managed care organizations, anticoagulation service, stroke prevention, non-valvular atrial fibrillation, older adults, quality of care, implementation feasibility, time in therapeutic range, usual care comparison
- MeSH terms
- Aged, Anticoagulants, Atrial Fibrillation, Female, Health Maintenance Organizations, Humans, Male, Managed Care Programs, Prothrombin Time, Quality of Health Care, Risk Factors, United States, Warfarin, International Normalized Ratio, Stroke
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