The DOI matches its Crossref record; 46 of the 48 references it cites were found in a registry or an index.
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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“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 the citing paper
“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 the citing paper
“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 the citing paper
“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 the citing paper
“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 the citing paper
“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 the citing paper
“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 the citing paper
“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 the citing paper
“Baseline outcomes Low risk No differences at baseline”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Matchar 2002
In the citing paper
“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
Citations
Cites
Statistical power analysis for the behavioral sciences
Cohen, J. (1990) · Computers Environment and Urban Systems · doi:10.1016/0198-9715(90)90050-4 · Cited by 65,417
Statistical Power Analysis for the Behavioral Sciences (2nd ed.).
Lachenbruch, P. A., & Cohen, J. (1989) · Journal of the American Statistical Association · doi:10.2307/2290095 · Cited by 37,421
Atrial fibrillation as an independent risk factor for stroke: the Framingham study
Wolf, P. A., Abbott, R. D., & Kannel, W. B. (1991) · Stroke · doi:10.1161/01.str.22.8.983 · Cited by 7,388
Risk Factors for Stroke and Efficacy of Antithrombotic Therapy in Atrial Fibrillation
(1994) · Archives of Internal Medicine · doi:10.1001/archinte.154.13.1449 · Cited by 2,643
Statistical Power Analysis for the Behavioral Sciences
(1977) · doi:10.1016/c2013-0-10517-x · Cited by 2,457
A Method to Determine the Optimal Intensity of Oral Anticoagulant Therapy
Rosendaal, F. R., Cannegieter, S. C., van der Meer, F. J. M., & Briët, E. (1993) · Thrombosis and Haemostasis · doi:10.1055/s-0038-1651587 · Cited by 2,070
EAFT (European Atrial Fibrillation Trial) Study Group (1993) · The Lancet · doi:10.1016/0140-6736(93)92358-z · Cited by 1,877
Petersen, P., GODTFREDSEN, J., Boysen, G., Andersen, E. D., & Andersen, B. (1989) · The Lancet · doi:10.1016/s0140-6736(89)91200-2 · Cited by 1,814
Oral Anticoagulants: Mechanism of Action, Clinical Effectiveness, and Optimal Therapeutic Range
Hirsh, J., Dalen, J. E., Anderson, D. R., Poller, L., Bussey, H. I., Ansell, J., & Deykin, D. (2001) · CHEST Journal · doi:10.1378/chest.119.1_suppl.8s · Cited by 1,813
Stroke Prevention in Atrial Fibrillation Study. Final results.
Prevention, S., & Atrial Fibrillation Investigators (1991) · Circulation · doi:10.1161/01.cir.84.2.527 · Cited by 1,696
Research works printed but not linked: 1
- Samsa, 1998, A seven-step model for practice improvement research, New Med, 2, 139
Cited by
Sorted by citations
Items 101–141 of 141
Mearns, E. S., Hawthorne, J., Song, J.-S., & Coleman, C. I. (2014) · BMJ Open · doi:10.1136/bmjopen-2014-005379 · Cited by 4
Atrial fibrillation in the elderly
Chen, J., & Rich, M. W. (2003) · Current Treatment Options in Cardiovascular Medicine · doi:10.1007/s11936-003-0042-8 · Cited by 3
Macle, L., & Andrade, J. G. (2015) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2015.06.025 · Cited by 3
“Unfortunately, despite strong evidence of clinical benefit, OAC use is limited by nonprescription (w 50% patients with an indication for treatment do not receive an OAC),(7,8) nonadherence (w 30% 1-year OAC discontinuation rate),(9) or subtherapeutic drug levels (w 25%-40% of patients taking warfarin have an internati…”
BackgroundFarmacología de dabigatrán y su manejo clínico
Fernández‐Armenta, J., & Brugada, J. (2012) · Revista Española de Cardiología Suplementos · doi:10.1016/s1131-3587(12)70047-x · Cited by 3
Alvadásgátló kezelésben részesülő betegek gyógyszer-adherenciája
Gadó, K., Kocsis, E., Zelkó, R., Hankó, B., Balogh, J. K., Forczig, M., & Domján, G. (2015) · Orvosi Hetilap · doi:10.1556/650.2015.30224 · Cited by 3
Martins, M. A. P., Oliveira, J. A. D. Q., Ribeiro, D. D., César, C. C., Junior, V. A. N., Moore-Palhares, D., Rocha, M. O. D. C., & Ribeiro, A. L. P. (2023) · Hemato · doi:10.3390/hemato4030018 · Cited by 3
Uribe, W., Reyes, J. M., & Gamboa, N. C. (2021) · Journal of Primary Care & Community Health · doi:10.1177/21501327211000213 · Cited by 3
Impact on patient care: patient case through the continuum of care
Kaatz, S. S. (2009) · Journal of Thrombosis and Thrombolysis · doi:10.1007/s11239-009-0408-1 · Cited by 3
“Although two randomized trials have failed to show improvements in the outcomes of thromboembolism or bleeding [15, 16], there are multiple non-randomized and randomized studies showing improvement in INR control when anticoagulation management services are compared to usual care [17].”
BackgroundWilshire, J., Smith, A. T., BÖHM, Á., & MacFadyen, R. J. (2004) · Scottish Medical Journal · doi:10.1177/003693300404900107 · Cited by 3
Assessment of emergency department patients' knowledge on oral anticoagulation therapy
Yaka, E., Pekdemir, M., Yılmaz, S., & AKALIN, L. E. (2011) · Turkish Journal of Emergency Medicine · doi:10.5505/1304.7361.2011.26214 · Cited by 3
The Use of Surrogate Outcome Measures
Whyte, J. J. (2007) · Humana Press eBooks · doi:10.1007/978-1-59745-004-1_19 · Cited by 3
Oral anticoagulant therapy and clinical outcomes in patients with atrial fibrillation
Aksan, G., Soylu, K., Demircan, S., Aksoy, O., Yanık, A. M., Gedikli, Ö., Yüksel, S., Şahin, M., & Yılmaz, Ö. (2014) · Blood Coagulation & Fibrinolysis · doi:10.1097/mbc.0000000000000127 · Cited by 2
Understanding low INR in clinical practice
Rose, A. J., & Hylek, E. M. (2009) · Thrombosis and Haemostasis · doi:10.1160/th09-01-0067 · Cited by 2
Semchuk, W., Levac, B., Lara, M., Shakespeare, A., Evers, T., & Bolt, J. (2013) · The Canadian Journal of Hospital Pharmacy · doi:10.4212/cjhp.v66i5.1286 · Cited by 2
“of patients with ≥ 1 comorbidities 54 (87) 38 (90) 76 (92) 168 (90) Cardiovascular disease 37 (60) 30 (71) 58 (70) 125 (67) Chronic pulmonary disease 15 (24) 16 (38) 18 (22) 49 (26) Non–insulin-dependent diabetes mellitus 0 (0) 0 (0) 1 (1) 1 (1) Risk factors 59 (95) 35 (83) 74 (89) 168 (90) Hypertension 24 (39) 12 (29…”
Bernaitis, N., Badrick, T. C., & Anoopkumar‐Dukie, S. (2020) · Journal of Thrombosis and Thrombolysis · doi:10.1007/s11239-020-02068-w · Cited by 2
Bleeding Due to Warfarin Treatment: Five Years of Experience
Koçak, S., Ertekin, B., Öztürk, E., Dündar, Z. D., Acar, T., & Girişgin, A. S. (2019) · Turkiye Klinikleri Cardiovascular Sciences · doi:10.5336/cardiosci.2019-65895 · Cited by 2
Zhao, Y., Liu, N., Wang, Y., & Hickey, K. T. (2016) · Personalized Medicine · doi:10.2217/pme.15.41 · Cited by 1
Tailored interventions to address determinants of practice
McHugh, S., Riordan, F., O'Mahony, A., McCarthy, L.-J., Navarro, A. C., Kerins, C., Murphy, J., Morrissey, E. C., O’Reilly, É. J., O'Connor, S., et al. (2026) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd005470.pub4 · Cited by 2
Sease, J. M., Blake, E., Gowan, M., & Shealy, K. M. (2011) · Journal of Pharmacy Technology · doi:10.1177/875512251102700102 · Cited by 1
DATA OF CLINICAL PRACTICE AS A TOOL FOR CHOICE OF DIRECT ORAL ANTICOAGULANT
Napalkov, D. A., Sokolova, A. A., & Fomin, V. (2017) · Rational Pharmacotherapy in Cardiology · doi:10.20996/1819-6446-2017-13-1-95-99 · Cited by 1
Bittinger, L., & TANG, A. S. L. (2012) · Europe PMC (PubMed Central) · doi:10.4022/jafib.364 · Cited by 1
Novel Therapeutics for Thromboprophylaxis in Nonvalvular Atrial Fibrillation
Gazı, E., Temız, A., Barutçu, A., & Çölkesen, Y. (2013) · Drug Development Research · doi:10.1002/ddr.21106
“The therapeutic INR range is achieved in only 60% of patients with AF [Matchar et al., 2002].”
BackgroundStein, P. D. (2007) · doi:10.1002/9780470692042.ch85
Safe and Effective Anticoagulation in the Outpatient Setting
Bloomfield, H. E., Taylor, B. C., Krause, A., Reddy, P., Greer, N. L., MacDonald, R. H., Rutks, I. R., & Wilt, T. J. (2011) · Cited by 6
Papillon‐Ferland, L., & Bergeron, J. (2003) · Pharmactuel
Kaatz, S. S. (2009) · Journal of Thrombosis and Thrombolysis · doi:10.1007/s11239-009-0415-2
“The only randomized trial testing the efficacy of an anticoagulation management service did not show a reduction in clinical adverse events [20]; however, there are many observational studies that have demonstrated improvement in the time in the therapeutic range which is a well accepted surrogate marker of good antic…”
BackgroundNew Anticoagulants for Atrial Fibrillation: The Beginning of a A New Era in Stroke Prevention
Gladstone, D. J., Earl, K. M., Bungard, T. J., Cox, J. L., Bell, A., Dorian, P., Dean, N., Huynh, T. T., Chopra, A., Eikelboom, J. W., et al. (2011) · Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques · doi:10.1017/s0317167100012312
Stroke prevention in patients with atrial fibrillation - anticoagulation strategy 2012
Syzdół, M., & Tendera, M. (2013) · Cor et Vasa · doi:10.1016/j.crvasa.2013.03.002 · Cited by 1
“As it is known from clinical trials, patient presenting with AF are in the therapeutic INR range only during 60% of treatment time and data from everyday practice show that this time is even shorter [7,8].”
BackgroundSocioeconomic Implications of Long-Term Warfarin Use
Menzin, J., Foster, T. S., & Audette, R. (2004) · Disease Management & Health Outcomes · doi:10.2165/00115677-200412060-00005
Novedades en anticoagulación. ¿Nos olvidamos ya de la heparina y las antivitaminas K? No
Salazar, V. R. (2012) · Revista Clínica Española · doi:10.1016/s0014-2565(12)70011-5
Emerging options to prevent stroke in atrial fibrillation patients
Silver, B. (2012) · Research Reports in Clinical Cardiology · doi:10.2147/rrcc.s17427
“30 These results are worse than those seen in more recent trials of anticoagulation for atrial fibrillation where time spent in target is at least 60%.”
Selection of Medications to Prevent Stroke Among Individuals With Atrial Fibrillation
Testa, L., Fasano, A. A., Sanctis, V. D., Latini, R. A., Latib, A., Oreglia, J., MARCO, F. D., Agnifili, M., Casavecchia, M., Talarico, G. P., et al. (2013) · Current Treatment Options in Neurology · doi:10.1007/s11940-013-0248-3
Gumulec, J., Kessler, P., Penka, M., Klodová, D., Králová, S., Brejcha, M., Wróbel, M., Blatný, J., Klaricová, K., & Lasota, Z. (2006)
Modelling in oral anticoagulation treatment
Nielsen, P. B. (2010) · VBN Forskningsportal (Aalborg Universitet)
Os Novos Anticoagulantes Orais no Tratamento da Fibrilhação Auricular
Brochado, F. E. R. (2013) · Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) · doi:10.34626/4qrm-5291
Antithrombotic treatment in patients with atrial fibrillation as a risk factor of stroke
Yaghy, M., Murín, J., Pernický, M., Pekarovicova, Z., & Mikes, P. (2008) · Bratislavské lekárske listy/Bratislava medical journal · doi:10.1007/bf03657025
Anticoagulation: The Successes and Pitfalls of Long-Term Management
Cucchi, E. W. (2017) · Physician Assistant Clinics · doi:10.1016/j.cpha.2017.06.003
Essays on supply chain and healthcare analytics
Wang, Y. (2017) · doi:10.7282/t3sf304n
“Warfarin dosing and INR prediction protocols and algorithms have been studied in the literature for initiation and maintenance of proper anticoagulation in patients under relatively stable clinical conditions [19, 22, 31-38], however limited”
BackgroundHempel, S., Ganz, D. A., Clifford, M., Newberry, S. J., Lim, Y.-W., Larkin, J., Shanman, R., Wertheimer, S. R., Wenger, N. S., Roth, C. P., et al. (2011)
Hempel, S., Ganz, D. A., Clifford, M., Newberry, S. J., Lim, Y.-W., Larkin, J., Shanman, R., Wertheimer, S. R., Wenger, N. S., Roth, C. P., et al. (2011)
bshabshe, A. A. A. A., Nadeem, M., Assiri, A. M., Wani, J. I., Aziz, S., Sabah, Z. U., Alqahtani, N. A., Alshehri, F., Alshubily, R. F., & Alqahtani, A. M. (2023) · Advances in Biomedical and Health Sciences · doi:10.4103/abhs.abhs_13_23
Metadata
- 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 › Clinical Neurology › 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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