Physician-Pharmacist Collaborative Clinic Model to Improve Anticoagulation Quality in Atrial Fibrillation Patients Receiving Warfarin: An Analysis of Time in Therapeutic Range and a Nomogram Development

作者全名："Wang, Na; Qiu, Sha; Yang, Ya; Zhang, Chi; Gu, Zhi-Chun; Qian, Yan"

作者地址："[Wang, Na; Qiu, Sha; Qian, Yan] Chongqing Med Univ, Affiliated Hosp 2, Dept Pharm, Chongqing, Peoples R China; [Yang, Ya] Shanghai Jiao Tong Univ, Sch Med, Renji Hosp, Dept Infect Control, Shanghai, Peoples R China; [Zhang, Chi; Gu, Zhi-Chun] Shanghai Jiao Tong Univ, Sch Med, Renji Hosp, Dept Pharm, Shanghai, Peoples R China; [Gu, Zhi-Chun] Shanghai Pharmaceut Assoc, Shanghai Anticoagulat Pharmacist Alliance, Shanghai, Peoples R China; [Gu, Zhi-Chun] Chinese Soc Cardiothorac & Vasc Anesthesiol, Beijing, Peoples R China"

通信作者："Qian, Y (corresponding author), Chongqing Med Univ, Affiliated Hosp 2, Dept Pharm, Chongqing, Peoples R China.; Gu, ZC (corresponding author), Shanghai Jiao Tong Univ, Sch Med, Renji Hosp, Dept Pharm, Shanghai, Peoples R China.; Gu, ZC (corresponding author), Shanghai Pharmaceut Assoc, Shanghai Anticoagulat Pharmacist Alliance, Shanghai, Peoples R China.; Gu, ZC (corresponding author), Chinese Soc Cardiothorac & Vasc Anesthesiol, Beijing, Peoples R China."

来源：FRONTIERS IN PHARMACOLOGY

ESI学科分类：PHARMACOLOGY & TOXICOLOGY

WOS号：WOS:000665799800001

JCR分区：Q1

影响因子：5.6

年份：2021

卷号：12

期号：　

开始页：　

结束页：　

文献类型：Article

关键词：atrial fibrillation; anticoagulation; warfarin; time in therapeutic range; prediction model; clinical pharmacist

摘要："Background: Poor time in therapeutic range (TTR) control is associated with an increased risk of stroke and bleeding in atrial fibrillation (AF) patients receiving warfarin. This study aimed to determine whether the physician-pharmacist collaborative clinic (PPCC) model could improve the anticoagulation quality as well as to create a nomogram for predicting anticoagulation quality in AF patients. Methods: This retrospective observational study enrolled AF patients who either initially received warfarin or returned to warfarin after withdrawal between January 1, 2016 and January 1, 2021, at our institution. The primary outcome was dynamic changes in TTRs (a TTR of >= 60% considered high anticoagulation quality). The secondary outcomes were thromboembolic and bleeding events during follow-up. We compared the dynamic changes in TTRs between the general clinic (GC) and PPCC groups in both the original and propensity score matching (PSM) cohorts. In addition, we explored the potential predictors of high anticoagulation quality and subsequently formulated a nomogram to predict anticoagulation quality. Results: A total of 265 patients with AF were included, comprising 57 patients in the PPCC group and 208 patients in the GC group. During a median follow-up period of 203 days, the PPCC group had a shorter time (76 vs. 199 days, p < 0.001) and more patients achieved a TTR >= 60% (73.7 vs. 47.1%, p = 0.002 by log-rank test) than the GC group. The results from the PSM cohort confirmed this finding. No significant differences in the incidences of thromboembolic events (5.3 vs. 5.3%, p = 1.000) and bleeding events (4.3 vs. 3.5%, p = 1.000) were observed between the two groups. Four variables were explored as predictors related to high anticoagulation quality: treatment within a PPCC, history of bleeding, history of bleeding, and the presence of more than four comorbidities. The nomogram revealed a moderate predictive ability (c-index: 0.718, 95% confidence interval (95%CI): 0.669-0.767) and a moderately fitted calibration curve. Conclusion: The PPCC model contributed to improved anticoagulation quality in AF patients receiving warfarin. The nomogram might be an effective tool to predict anticoagulation quality and could aid physicians and pharmacists in the selection of patients who will likely benefit from sustained and active intervention."

基金机构：Social Undertakings and Livelihood Security Science and Technology Innovation Project of Chongqing Science and Technology Commission [cstc2017shmsA130041]; Technical Innovation and Application Development Special Project of Chongqing Science and Technology Commission [cstc2019jscx-msxmX0208]; Research Funds of Shanghai Health and Family Planning commission [20184Y0022]; Cultivation fund of clinical research of Renji Hospital [PY2018-III-06]; Clinical Pharmacy Innovation Research Institute of Shanghai Jiao Tong University School of Medicine [CXYJY2019ZD001]; Shanghai "Rising Stars of Medical Talent" Youth Development Program-Youth Medical Talents-Clinical Pharmacist Program (SHWJRS [(2019)_072]

基金资助正文："This study was supported by Social Undertakings and Livelihood Security Science and Technology Innovation Project of Chongqing Science and Technology Commission (cstc2017shmsA130041). Technical Innovation and Application Development Special Project of Chongqing Science and Technology Commission (cstc2019jscx-msxmX0208). Research Funds of Shanghai Health and Family Planning commission (20184Y0022), Cultivation fund of clinical research of Renji Hospital (PY2018-III-06), Clinical Pharmacy Innovation Research Institute of Shanghai Jiao Tong University School of Medicine (CXYJY2019ZD001), and Shanghai ""Rising Stars of Medical Talent"" Youth Development Program-Youth Medical Talents-Clinical Pharmacist Program (SHWJRS (2019)_072)."