The Adherence to Initial Processes of Care in Elderly Patients with Acute Venous ThromboembolismReport as inadecuate




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Background

We aimed to assess whether elderly patients with acute venous thromboembolism VTE receive recommended initial processes of care and to identify predictors of process adherence.

Methods

We prospectively studied in- and outpatients aged ≥65 years with acute symptomatic VTE in a multicenter cohort study from nine Swiss university- and non-university hospitals between September 2009 and March 2011.We systematically assessed whether initial processes of care, which are recommended by the 2008 American College of Chest Physicians guidelines, were performed in each patient. We used multivariable logistic models to identify patient factors independently associated with process adherence.

Results

Our cohort comprised 950 patients mean age 76 years. Of these, 86% 645-750 received parenteral anticoagulation for ≥5 days, 54% 405-750 had oral anticoagulation started on the first treatment day, and 37% 274-750 had an international normalized ratio INR ≥2 for ≥24 hours before parenteral anticoagulation was discontinued. Overall, 35% 53-153 of patients with cancer received low-molecular-weight heparin monotherapy and 72% 304-423 of patients with symptomatic deep vein thrombosis were prescribed compression stockings. In multivariate analyses, symptomatic pulmonary embolism, hospital-acquired VTE, and concomitant antiplatelet therapy were associated with a significantly lower anticoagulation-related process adherence.

Conclusions

Adherence to several recommended processes of care was suboptimal in elderly patients with VTE. Quality of care interventions should particularly focus on processes with low adherence, such as the prescription of continued low-molecular-weight heparin therapy in patients with cancer and the achievement of an INR ≥2 for ≥24 hours before parenteral anticoagulants are stopped.



Author: Anna K. Stuck , Marie Méan, Andreas Limacher, Marc Righini, Kurt Jaeger, Hans-Jürg Beer, Joseph Osterwalder, Beat Frauchiger, C

Source: http://plos.srce.hr/



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