Afib Treatment Benefits from Patient Self-Management

Patient self-management is an emerging anticoagulation delivery model that capitalizes on patients’ willingness for in-depth warfarin education to help treat their atrial fibrillation.

Previous meta-analyses of randomized, controlled trials have linked patient self-management to significant reductions in thromboembolic events and mortality compared with traditional anticoagulation delivery models.

Guidelines recommend patient self-management training programs cover coagu­lation, drug interactions, monitoring, evaluation of international normalized ratio (INR) results, dose adjustments, bleeding signs and symptoms, thrombosis, record keeping, travel, and nutrition.

A team of researchers from Kaiser Permanente Colorado assessed the superiority of patient self-management programs in a recent issue of The Permanente Journal.

The study authors initiated a prospective, intervention-only, open-label patient self-management pilot program with venipuncture results provided through a secure site.

The researchers also developed a dosing algorithm and a 2-hour class on patient self-management for those enrolled.

Participants had diagnosed atrial fibrillation and were at least 18 years old. Their goal INR was 2 to 3, and they had been treated with warfarin for at least 6 months at baseline and were able to access Kaiser Permanente’s online platform.

The study used venipuncture-based INR testing that reported results digitally with no delay.

The study authors noted that adherence rates were artificially high because the authors excluded patients who missed more than 1 INR test in the previous 6 months.

Patients who were excluded from participation were older and had more severe atrial fibrillation. Younger patients with less severe atrial fibrillation were more likely to enroll.

Patient self-management training improved patients’ mean competency from 55.8% to 88.8% and passing competency scores from 34.9% to 95.3%.

Educating patients was a significant cost, however. Fifty-two staff hours were required to train 44 patients.

The study authors suggested using online webinars to train patients in order to reduce training costs and transportation difficulty.

This study supports the feasibility of patient self-management warfarin therapy using venipuncture and digital result release.