Warfarin treatment among Finnish patients with atrial fibrillation: retrospective registry study based on primary healthcare data

Abstract

Objective: To assess the frequency of warfarin use, the achieved international normalised ratio (INR) balance among warfarin users and the primary healthcare outpatient costs of patients with atrial fibrillation (AF).

Design: Retrospective, non-interventional registry study.

Setting: Primary healthcare.

Participants: All patients with AF (n=2746) treated in one Finnish health centre between October 2010 and March 2012.

Methods: Data on healthcare resource use, warfarin use, individually defined target INR range and INR test results were collected from the primary healthcare database for patients with AF diagnosis. The analysed dataset consisted of a 1-year follow-up. Warfarin treatment balance was estimated with the proportion of time spent in the therapeutic INR range (TTR). The cost of used healthcare resources was valued separately with national and service provider unit costs to estimate the total outpatient treatment costs. The factors potentially impacting the treatment costs were assessed with a generalised linear regression model.

Results: Approximately 50% of the patients with AF with CHADS-VASc ≥1 used warfarin. The average TTR was 65.2% but increased to 74.5% among patients using warfarin continuously (ie, without gaps exceeding 56 days between successive INR tests) during follow-up. One-third of the patients had a TTR of below 60%. The average outpatient costs in the patient cohort were €314.44 with the national unit costs and €560.26 with the service provider unit costs. The costs among warfarin users were, on average, €524.11 or €939.54 higher compared with the costs among non-users, depending on the used unit costs. A higher TTR was associated with lower outpatient costs.

Conclusions: The patients in the study centre using warfarin were, on average, well controlled on warfarin, yet one-third of patients had a TTR of below 60%.

Keywords: Primary Care.

Figure 1

Number of patients alive and dead (in June 2012) in each TTR subgroup. TTR, time in therapeutic range.

Figure 2

Proportion of patients reaching different TTR levels according to patients’ defined target INR range. Defined target range, individual INR target range specified in the database. TTR, time in therapeutic range.