Atrial fibrillation in general practice – NOAC vs VKA
- Janni Kristensen
Formål med projektet
The number of patients with atrial fibrillation is increasing with the ageing population. In atrial fibrillation NOACs (Non - vitamin K oral anticoagulants) are the new drugs of choice for most of our patients, replacing VKA/warfarin. Economical ressources are limited in general practice in Denmark and wise use of money and human ressources is necessary. Regulation of VKA dose is rather complicated and dependent on professionel experience, requiring instruction and education of doctors/employees.
Fewer check-ups are needed with NOACs - saving time for doctors/employees and thereby money for the public social security in Denmark.
In this small study in our clinic we looked at
•the number of patients with atrial fibrillation
•the quality of treatment and yearly status and correct billing/charge
•which medication did the patients receive?
•do the patients accept a change in medication from VKA to NOAC?
Out of 5189 listed patients in the clinic, 219 had a diagnosis of atrial fibrillation. 186 (85%) received NOACS and 33 (15%) received VKA/warfarin. Patients who received VKA/warfarin were invited to an appointment with the doctor where potential benefits and harms of changing to a NOAC was discussed.
The project also investigated the quality of VKA treatment and control in the clinic.
After receiving information of potential benefits and harms of NOACS, 10 changed permanently to NOAC.
Out of 33 treated with VKA/warfarin:
• 12 patients had (time in therapeutic interval ) TTI < 70 % during the last year
(mostly INR higher than 2,5)
• 4 patients was not tested for diabetes or hyperlipidemia in one year
• 10 patients had no listed blodpressure mesurement in one year
• 6 patients with no ECG in one year
• In 12 patients no notes were made in file concerning functionel level and
symptoms during exercise.
• In 20 patients we did not charge for yearly status check-up (0120)
- 7 of these had other cronic morbidities for which we charged 0120 status)
• The major part of our patients with AF was treated with NOACS (85%)
• All though warfarin treated patients were seen often for INR measuring in our clinic,
the TTI was not as high as recommended.
• Yearly status was rather often missed and the right billing was missing in many of
these patients all though the work was done. Often these patients were seen with
• New employees in our lab may be part of the explanation in joint venture with low
doctor awarenes on status control and billing.
• Though NOACS are the new drugs of choice not all patients are suited for - or wish
to - change from VKA
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