Health Care of Patients with Atrial Fibrillation Treated with Vitamin K Antagonists in Germany
DOI: 10.3238/zfa.2019.0259-0264german translation / full article
Background: When vitamin K antagonists (VKA) are used, a time of ≥ 70 % in a target range of the International Normalized Ratio (INR) between 2 and 3 is targeted for effective stroke prevention. Some studies show that only a small number of patients are within this therapeutic range, with country-specific differences. However, certain studies from Germany suggest that anticoagulation is well adjusted. Yet, data obtained from studies conducted in everyday health care settings have not been assessed in a systematic approach. Therefore, our research addresses the quality of oral anticoagulation (OAC) among patients with atrial fibrillation treated with VKA in Germany‘s everyday health care. Methods: A systematic review on the quality of OAC with VKA for patients suffering from atrial fibrillation was conducted. Observational and randomized controlled trials were identified using bibliographic databases and manual literature search. Two reviewers independently performed study selection and methodological assessment according to international criteria and standardized checklists. Results: Quality of OAC was assessed by means of the time in therapeutic range (TTR) or the INR. We consistently found a high heterogeneity of the investigated populations and poor data quality. In no study TTR values were collected over a longer period of time. In most cases, there was also a high potential for bias. Conclusions: Due to the heterogeneous studies and the included patient populations, the OAC quality cannot be assessed in Germany‘s everyday health care, which makes further investigations with long follow-up and without interventions necessary.