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Patient satisfaction with extended-interval warfarin monitoring

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Abstract

Extended-interval monitoring of warfarin has been proposed to reduce follow-up burden and improve patient satisfaction. We aimed to make an initial assessment of anticoagulation satisfaction before and after an extended-interval warfarin monitoring intervention. We conducted a translational prospective single-arm pilot study of extended-interval warfarin monitoring in five pharmacist-managed anticoagulation clinics. Patients meeting CHEST guideline criteria for extended-interval warfarin monitoring began progressive extended-interval follow-up (6, 8, and 12 weeks thereafter). The Duke Anticoagulation Satisfaction Scale (DASS) was administered at baseline and at end-of-study or study removal (in patients no longer appropriate for extended interval follow-up). Forty-six patients had evaluable pre- and post-intervention DASS survey data. Mean age of patients was 66.5 years, 74 % were non-Hispanic whites, and 48 % were men. Patients completed a mean ± SD of 34 ± 22 weeks of follow-up. Mean ± SD total DASS score at baseline was 45.2 ± 14.2 versus 49.1 ± 14.9 at end-of-study (mean change, +3.9 [95 % CI −0.6–8.4; p = 0.09]), indicating no benefit—and trending toward decrement—to anticoagulation satisfaction. Change in anticoagulation satisfaction varied substantially following extended-interval monitoring, with no evidence of improved satisfaction. Plausible reasons for patients not preferring extended-interval monitoring include increased anxiety and disengagement from self-management activities, both potentially related to less frequent feedback and reassurance during extended interval-monitoring. Additional research is needed to identify who is likely to benefit most from extended-interval monitoring. Anticoagulation satisfaction should be considered with clinical factors and shared-decision making when implementing extended-interval warfarin monitoring.

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Authors and Affiliations

  1. Department of Pharmacotherapeutics and Clinical Research, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd., MDC 30, Tampa, FL, 33612-4749, USA

    Nicholas W. Carris

  2. Department of Family Medicine, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., MDC 30, Tampa, FL, 33612, USA

    Nicholas W. Carris

  3. Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, P.O Box 100486, Gainesville, FL, 32610, USA

    Andrew Y. Hwang, Steven M. Smith, James R. Taylor, Karen Sando, Jason Powell, John G. Gums, Eric A. Dietrich & Katherine Vogel Anderson

  4. Department of Community Health and Family Medicine, College of Medicine, University of Florida, 1707 N. Main St., Gainesville, FL, 32609, USA

    Andrew Y. Hwang, Steven M. Smith, Karen Sando, John G. Gums & Eric A. Dietrich

  5. Division of General Internal Medicine, College of Medicine, University of Florida, 2000 SW Archer Rd, 4th Floor, Suite 4592, Gainesville, FL, 32608, USA

    Eric I. Rosenberg & Katherine Vogel Anderson

  6. Division of Hematology/Oncology, College of Medicine, University of Florida, 2000 SW Archer Rd, 3rd Floor, Gainesville, FL, 32608, USA

    Marc S. Zumberg

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  1. Nicholas W. Carris
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  2. Andrew Y. Hwang
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  3. Steven M. Smith
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Corresponding author

Correspondence to Nicholas W. Carris.

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Conflict of interest

Dr. Marc S. Zumberg reports being the medical director for NCF diagnostics and DNA technology.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Carris, N.W., Hwang, A.Y., Smith, S.M. et al. Patient satisfaction with extended-interval warfarin monitoring. J Thromb Thrombolysis 42, 486–493 (2016). https://doi.org/10.1007/s11239-016-1385-9

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  • DOI: https://doi.org/10.1007/s11239-016-1385-9

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