The adherence to initial processes of care in elderly patients with acute venous thromboembolism.

Stuck, Anna K.; Méan Pascual, Marie; Limacher, Andreas; Righini, Marc; Jaeger, Kurt; Beer, Hans-Jürg; Osterwalder, Joseph; Frauchiger, Beat; Matter, Christian M.; Kucher, Nils; Egloff, Michael; Aschwanden, Markus; Husmann, Marc; Angelillo-Scherrer, Anne; Rodondi, Nicolas; Aujesky, Drahomir (2014). The adherence to initial processes of care in elderly patients with acute venous thromboembolism. PLoS ONE, 9(7), e100164. Public Library of Science 10.1371/journal.pone.0100164

[img]
Preview
Text
journal.pone.0100164.pdf - Published Version
Available under License Creative Commons: Attribution (CC-BY).

Download (442kB) | Preview

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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Haematology and Central Haematological Laboratory
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Angiology

UniBE Contributor:

Méan Pascual, Marie; Limacher, Andreas; Kucher, Nils; Angelillo, Anne and Aujesky, Drahomir

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1932-6203

Publisher:

Public Library of Science

Language:

English

Submitter:

Catherine Gut

Date Deposited:

18 Jul 2014 09:31

Last Modified:

23 Jun 2015 13:38

Publisher DOI:

10.1371/journal.pone.0100164

PubMed ID:

24983634

BORIS DOI:

10.7892/boris.54532

URI:

https://boris.unibe.ch/id/eprint/54532

Actions (login required)

Edit item Edit item
Provide Feedback