Attainment of Target in Therapeutic Range of International Normalized Ratio and Correlates Among Patients on Warfarin Therapy at Jimma Medical Center, Jimma, Ethiopia.

PURPOSE: Warfarin is effective therapy to prevent thromboembolic complications of venous thromboembolism, atrial fibrillation, and cardiac thrombus, among valvular heart diseases, including in patients treated with prostheses and/or repair. Its optimum effect is achieved when the international normalized ratio (INR) is in the target therapeutic range, but a subtherapeutic level increases risk of thromboembolism and complications. This study aimed to assess the attainment of target therapeutic range, proportion, and factors associated with subtherapeutic level of warfarin. METHODS: A hospital-based cross-sectional study was conducted at Jimma Medical Center in Jimma, Ethiopia, from October 1, 2020 through December 30, 2021. All patients on warfarin and attending Medical Follow-Up Clinics of Jimma Medical Center during the study period were included. Data were collected using structured questionnaires and then analyzed using EpiData Manager software, version 3.1 (EpiData Association). χ2 Tests and logistic regression models were used to assess relationships among variables. FINDINGS: Of 196 patients on warfarin, ∼60% were taking it for atrial fibrillation, followed by deep venous thrombosis, women accounted for 61.7% of patients, and mean (SD) age was 43 (7) years. Most patients (61.7%) lived in rural areas and 44.9% farmed to earn a living. Most of the study participants (51.5%) had a very low monthly income of less than USD50. Most of the patients (n = 107 [54.6%]) were advised on dietary selections while on warfarin and approximately two-thirds (n = 70 [65.4%]) were adherent to the advice. Most participants (n = 118 [60.2%]) were poorly adherent to warfarin therapy and more than two-thirds of them discontinued warfarin for financial reasons. Mean (SD) duration of warfarin therapy was 15.53 (18.92) months (range 1-90 months). Most of the respondents (n = 109 [55.6%]) had subtherapeutic INR and 21 (10.7%) were in the supratherapeutic range. Although the mean (SD) time in therapeutic range was 25.03% (24.17% [range 0-80%]), in most patients (n = 166 [84.7%]), it was <60%. Poor adherence (adjusted odds ratio = 6.13; 95% CI, 3.31-28.10), shorter duration of warfarin (<12 months; adjusted odds ratio = 0.104; 95% CI, 0.012-0.875), and presence of comorbidity (adjusted odds ratio = 0.035; 95% CI, 0.004-0.323) were significantly associated with subtherapeutic INR. IMPLICATIONS: Attainment of therapeutic INR among patients on warfarin therapy is suboptimal. This was evidenced by a significant number of patients with low time in therapeutic range, as well as INR. Poor adherence to warfarin therapy, shorter duration since initiation of warfarin, and presence of comorbid illnesses were significantly associated with subtherapeutic INR. This can lead to complications of atrial fibrillation, including thrombus formation and subsequent cardioembolic stroke, venous thromboembolism, and others, leading to morbidity, increased mortality, and poor quality of life. Therefore, providing health education and treatment for comorbidities may improve adherence, which may also improve attainment of therapeutic INR and reduce complications and improve quality of life.

Mortality and Its Associated Factors among Hospitalized Heart Failure Patients : The Case of South West Ethiopia.

BACKGROUND: Hospital case fatality among those with heart failure in Africa ranges from 9% to 12.5%. An integrated approach to identify those who are at high risk and implementing specific treatment strategies is of great importance for a better outcome. OBJECTIVE: The aim of this study is to assess the mortality rate and its associated factors among hospitalized heart failure patients at the Jimma University Medical Center (JUMC), south west Ethiopia. METHOD: A hospital-based retrospective cross-sectional study design was conducted among 252 patients admitted with heart failure during the study period who were sampled and enrolled in to the study. A simple random sampling technique was used to select the study participants by using their medical registration number as the sampling frame. Data were collected using a pretested questionnaire. The collected data were entered into EpiData software and exported to SPSS version 20 for cleaning and analysis. A binary logistic regression model was used. Adjusted and crude odds ratio with 95% CI were used. A P value less than 0.05 was used to declare statistical significance. RESULTS: The prevalence of in-hospital mortality was found to be 21.29%. Cardiogenic shock AOR: 0.016 (95% CI: 0.001-0.267), complication at admission AOR: 5.25 (95% CI: 1.28-21.6), and ejection fraction (<30) AOR: 0.112 (95% CI: 0.022-0.562) were found to be significantly associated factors. CONCLUSION: The in-hospital mortality rate among admitted heart failure patients is unacceptably high. Due emphasis should be given on the identified associated factors to reduce the mortality.