Age-Dependent RGS5 Loss in Pericytes Induces Cardiac Dysfunction and Fibrosis.

BACKGROUND: Pericytes are capillary-associated mural cells involved in the maintenance and stability of the vascular network. Although aging is one of the main risk factors for cardiovascular disease, the consequences of aging on cardiac pericytes are unknown. METHODS: In this study, we have combined single-nucleus RNA sequencing and histological analysis to determine the effects of aging on cardiac pericytes. Furthermore, we have conducted in vivo and in vitro analysis of RGS5 (regulator of G-protein signaling 5) loss of function and finally have performed pericytes-fibroblasts coculture studies to understand the effect of RGS5 deletion in pericytes on the neighboring fibroblasts. RESULTS: Aging reduced the pericyte area and capillary coverage in the murine heart. Single-nucleus RNA sequencing analysis further revealed that the expression of Rgs5 was reduced in cardiac pericytes from aged mice. In vivo and in vitro studies showed that the deletion of RGS5 impaired cardiac function, induced fibrosis, and morphological changes in pericytes characterized by a profibrotic gene expression signature and the expression of different ECM (extracellular matrix) components and growth factors, for example, TGFB2 and PDGFB. Indeed, culturing fibroblasts with the supernatant of RGS5-deficient pericytes induced their activation as evidenced by the increased expression of αSMA (alpha smooth muscle actin) in a TGFß (transforming growth factor beta)2-dependent mechanism. CONCLUSIONS: Our results have identified RGS5 as a crucial regulator of pericyte function during cardiac aging. The deletion of RGS5 causes cardiac dysfunction and induces myocardial fibrosis, one of the hallmarks of cardiac aging.

Potential usages of A-to-I RNA editing patterns as diagnostic biomarkers.

Adenosine to inosine (A-to-I) RNA editing is one of the most frequent RNA modifications found in the mammalian transcriptome. Recent studies clearly indicate that RNA editing enzymes, adenosine deaminase acting on RNAs (ADARs), are upregulated in stressed cells and under disease conditions, suggesting that monitoring RNA editing patterns might be useful as diagnostic biomarkers of various diseases. Here, we provide an overview of epitranscriptomics, and focus particularly on the detection and analysis of A-to-I RNA editing using bioinformatic tools in RNA-seq data sets, as well as briefly reviewing the existing evidence about its involvement in disease progressions. Finally, we argue for the detection of RNA editing patterns as part of the routine analysis in RNA-based data sets, with the aim of accelerating the identification of RNA editing targets linked to disease.

Effectiveness of a virtual intervention for primary healthcare professionals aimed at improving attitudes towards the empowerment of patients with chronic diseases: study protocol for a cluster randomized controlled trial (e-MPODERA project).

BACKGROUND: Communities of practice are based on the idea that learning involves a group of people exchanging experiences and knowledge. The e-MPODERA project aims to assess the effectiveness of a virtual community of practice aimed at improving primary healthcare professional attitudes to the empowerment of patients with chronic diseases. METHODS: This paper describes the protocol for a cluster randomized controlled trial. We will randomly assign 18 primary-care practices per participating region of Spain (Catalonia, Madrid and Canary Islands) to a virtual community of practice or to usual training. The primary-care practice will be the randomization unit and the primary healthcare professional will be the unit of analysis. We will need a sample of 270 primary healthcare professionals (general practitioners and nurses) and 1382 patients. We will perform randomization after professionals and patients are selected. We will ask the intervention group to participate for 12 months in a virtual community of practice based on a web 2.0 platform. We will measure the primary outcome using the Patient-Provider Orientation Scale questionnaire administered at baseline and after 12 months. Secondary outcomes will be the sociodemographic characteristics of health professionals, sociodemographic and clinical characteristics of patients, the Patient Activation Measure questionnaire for patient activation and outcomes regarding use of the virtual community of practice. We will calculate a linear mixed-effects regression to estimate the effect of participating in the virtual community of practice. DISCUSSION: This cluster randomized controlled trial will show whether a virtual intervention for primary healthcare professionals improves attitudes to the empowerment of patients with chronic diseases. TRIAL REGISTRATION: ClicalTrials.gov, NCT02757781 . Registered on 25 April 2016. Protocol Version. PI15.01 22 January 2016.

Concordancia y utilidad de un sistema de estratificación para la toma de decisiones clínicas / Concordance and usefulness of a stratification system for clinical decision making

OBJETIVOS: 1) Analizar la concordancia entre la clasificación por niveles de riesgo del agrupador grupos de morbilidad ajustados (GMA) y el nivel de intervención asignado por los médicos de familia (MF). 2) Estudiar la utilidad del agrupador como herramienta de ayuda en historia clínica electrónica (HCE) para la toma de decisiones clínicas. DISEÑO: Estudio observacional transversal de concordancia. Emplazamiento: Atención Primaria, Servicio Madrileño de Salud. PARTICIPANTES: Veintiocho MF. Se seleccionó una muestra de 840 pacientes adscritos a cupos de los MF participantes por muestreo aleatorizado estratificado no proporcional (kappa 0,65, precisión 0,125, porcentajes positivos 5%, nivel de confianza 95%). Mediciones principales: Índice kappa de Cohen ponderado para el grado de concordancia entre el nivel (bajo, medio o alto) de riesgo de ingreso hospitalario/consumo de recursos del paciente propuesto por el agrupador GMA y el nivel (bajo, medio o alto) de intervención (autocuidado, gestión de la enfermedad, gestión del caso) asignado por el MF. A través de un cuestionario autoadministrado elaborado ad hoc los MF valoraron la utilidad del agrupador. RESULTADOS: El índice de kappa ponderado obtenido fue de 0,60 (IC 95% 0,55-0,65). En un 3% el grado de desacuerdo fue máximo. El MF consideró en el 76% de los casos que el agrupador había sido útil para la asignación de los niveles de intervención. CONCLUSIÓN: La fuerza de concordancia obtenida fue moderada/buena; la incorporación de un agrupador en la HCE puede servir de ayuda como recordatorio para una toma de decisiones más proactiva/integrada según las necesidades sociosanitarias de las personas con enfermedades crónicas

OBJECTIVES: 1) To analyse concordance between the level of risk classification using the Adjusted Groups Morbidity (GMA) tool and the assigned level of intervention by general practitioners (GP). 2) To study the usefulness of the GMA tool as an aid in electronic medical records (EMR) for decision making. DESIGN: Cross-sectional observational study of concordance. LOCATION: Primary Care. Madrid Health Service. PARTICIPANTS: Twenty eight GPs. A sample of 840 patients assigned to participating GPs was selected by disproportionate stratified random sampling (0.65 kappa, 0.125 precision, 5% positive rate, 95% confidence level). MAIN MEASUREMENTS: Weighted Cohen Kappa index for the degree of concordance between the GMA tool and the GPs. The usefulness of the tool was assessed using an ad hoc developed questionnaire. RESULTS: Kappa weighted index obtained was 0.60 (95% CI: 0.55-0.65). In 3% of cases the disagreement was maximum. The GPs found that the grouping tool had been useful in 76% of cases. CONCLUSION: Moderate strength/good concordance; incorporating a grouping tool in the EMR helps as a reminder for taking more proactive/integrated decisions based on social and health needs of people with chronic diseases

[Concordance and usefulness of a stratification system for clinical decision making]. / Concordancia y utilidad de un sistema de estratificación para la toma de decisiones clínicas.

OBJECTIVES: 1) To analyse concordance between the level of risk classification using the Adjusted Groups Morbidity (GMA) tool and the assigned level of intervention by general practitioners (GP). 2) To study the usefulness of the GMA tool as an aid in electronic medical records (EMR) for decision making. DESIGN: Cross-sectional observational study of concordance. LOCATION: Primary Care. Madrid Health Service. PARTICIPANTS: Twenty eight GPs. A sample of 840 patients assigned to participating GPs was selected by disproportionate stratified random sampling (0.65 kappa, 0.125 precision, 5% positive rate, 95% confidence level). MAIN MEASUREMENTS: Weighted Cohen Kappa index for the degree of concordance between the GMA tool and the GPs. The usefulness of the tool was assessed using an ad hoc developed questionnaire. RESULTS: Kappa weighted index obtained was 0.60 (95%CI: 0.55-0.65). In 3% of cases the disagreement was maximum. The GPs found that the grouping tool had been useful in 76% of cases. CONCLUSION: Moderate strength/good concordance; incorporating a grouping tool in the EMR helps as a reminder for taking more proactive/integrated decisions based on social and health needs of people with chronic diseases.

Evaluación sobre historia clínica electrónica. Asociación entre indicadores de proceso medidos sobre historia electrónica y resultados intermedios en salud, en pacientes con hipertensión / Assessment of electronic medical records. Relationship between process indicators measured using electronic records and intermediate health outcomes in patients with hypertension

Objetivo: Determinar, en pacientes con hipertensión, si la medición sobre historia electrónica de cada indicador de proceso del Sermas, se asocia a resultados intermedios en salud. Diseño: Estudio epidemiológico descriptivo transversal. Emplazamiento: Área 1 de Atención Primaria de Madrid. 2010. Participantes: Todos los pacientes del Área con hipertensión. n=80.306. Mediciones principales: Variables independientes. Indicadores institucionales de proceso (Cartera de Servicios). Dependientes. Resultados intermedios: cifras controladas de tensión arterial (TA), LDL, y peso, no consumo de tabaco y detección de complicaciones. Potencialmente confusoras. Edad y sexo, comorbilidad, fármacos y variables del profesional. Resultados: El 55,1% (ES 0,2%) tenía cifras controladas de TA. En el análisis bivariante y multivariante mediante regresión logística, el registro de algunos indicadores de proceso se asoció con un aumento, en general moderado, de la probabilidad de alcanzar resultados intermedios: consejo tabaco (OR: 1,69; IC95%: 1,61-1,77), revisión antecedentes (OR: 1,54; IC95%: 1,42-1,68), medición TA (OR: 1,19; IC95%: 1,14-1,25), iones (OR: 1,14; IC95%: 1,09-1,19), IMC (OR: 1,08; IC95%: 1,04-1,12); también medición de glucemia, edemas y creatinina pero con sesgo temporal. En otros indicadores no se encontró asociación (intervenciones en estilo de vida, antecedentes familiares, clasificación, orina, revisión tratamiento farmacológico, LDL, EKG y auscultación cardiaca)(AU)

Conclusiones: En hipertensión, se encontró asociación entre algunos indicadores de proceso del Sermas, medidos sobre historia electrónica, y un aumento moderado de la probabilidad de alcanzar resultados intermedios en salud. Parece recomendable integrar en la cartera de servicios la medición de resultados e incorporar otras intervenciones de impacto, priorizar mejoras en indicadores de baja realización y alto impacto y eliminar o modificar sustancialmente indicadores sin asociación con resultados(AU)

Objective: To study relationship between institutional process indicators (measured using electronic records) and intermediate outcomes of patients with hypertension. Design: Cross-sectional epidemiological study. Setting: Primary Care Health District 1. Madrid. 2010.PatientsAll patients with hypertension. n=80,306. Main measurements: Variables. Independent. Institutional process indicators. Dependent. Intermediate outcomes: blood pressure within target limits, LDL-cholesterol, tobacco and weight and detected complications. Confounding. Age, gender, co-morbidity, drugs and professional variables. Results: The BP of 55.1% (SE 0.2%) of patients was within target limits. Bivariate analysis and multivariate logistic regression showed that the recording of some process indicators was associated with an increase in the probability to achieve targets in intermediate outcomes: smoking advice (OR: 1.69, 95% CI: 1.61 - 1.77), reviewing personal history (OR: 1.54, 95% CI:1.42-1.68), increase was less or biased: BP (OR: 1.19, 95% CI:1.14-1.25), sodium and potassium (OR: 1.14, 95% CI:1.09-1.19), BMI (OR 1.08, 95% CI:1.04-1.12); also diabetes, edema, and creatinine, but there was timing bias. The relationship between other indicators (those oriented to lifestyle, family history, classification, urine examination, reviewing of drug therapy, LDL, electrocardiogram and cardiac auscultation) and a higher probability to achieve targets was not found(AU)

Conclusions: In hypertension, some institutional process indicators measured on electronic records were associated with an increase in the probability to achieve targets in intermediate outcomes. No relationship was found between other indicators. This suggests maintaining process and outcome measurement, to include the impact of interventions, to prioritize improvements in process indicators that show low performance and high impact and to remove or to change process indicators where no relationship is found(AU)

[Assessment of electronic medical records. Relationship between process indicators measured using electronic records and intermediate health outcomes in patients with hypertension]. / Evaluación sobre historia clínica electrónica. Asociación entre indicadores de proceso medidos sobre historia electrónica y resultados intermedios en salud, en pacientes con hipertensión.

OBJECTIVE: To study relationship between institutional process indicators (measured using electronic records) and intermediate outcomes of patients with hypertension. DESIGN: Cross-sectional epidemiological study. SETTING: Primary Care Health District 1. Madrid. 2010. PATIENTS: All patients with hypertension. n=80,306. MAIN MEASUREMENTS: Variables. Independent. Institutional process indicators. Dependent. Intermediate outcomes: blood pressure within target limits, LDL-cholesterol, tobacco and weight and detected complications. Confounding. Age, gender, co-morbidity, drugs and professional variables. RESULTS: The BP of 55.1% (SE 0.2%) of patients was within target limits. Bivariate analysis and multivariate logistic regression showed that the recording of some process indicators was associated with an increase in the probability to achieve targets in intermediate outcomes: smoking advice (OR: 1.69, 95% CI: 1.61 - 1.77), reviewing personal history (OR: 1.54, 95% CI:1.42-1.68), increase was less or biased: BP (OR: 1.19, 95% CI:1.14-1.25), sodium and potassium (OR: 1.14, 95% CI:1.09-1.19), BMI (OR 1.08, 95% CI:1.04-1.12); also diabetes, edema, and creatinine, but there was timing bias. The relationship between other indicators (those oriented to lifestyle, family history, classification, urine examination, reviewing of drug therapy, LDL, electrocardiogram and cardiac auscultation) and a higher probability to achieve targets was not found. CONCLUSIONS: In hypertension, some institutional process indicators measured on electronic records were associated with an increase in the probability to achieve targets in intermediate outcomes. No relationship was found between other indicators. This suggests maintaining process and outcome measurement, to include the impact of interventions, to prioritize improvements in process indicators that show low performance and high impact and to remove or to change process indicators where no relationship is found.

[Implementation and improvement in a care program for the elderly on multiple medications in a primary care area]. / Implantación y mejora de un programa de atención al mayor polimedicado en un área de atención primaria.

BACKGROUND: The purpose is to describe the introduction of a Care Program for the Elderly on Multiple Medication in a Primary Care area and the complete improvement cycle after evaluating the initial results The Program was instigated by the Community of Madrid Pharmacy Directorate. METHODS: The Program was aimed at patients over 75 years who took 6 or more active ingredients (9721 patients in the area at the start of the program) and began in September 2006. It is based on coordinating with pharmacists, systematic review of treatment, health education, and the providing of personal dose dispensing systems for the correct use of the medication. Before its introduction, all the health professionals and pharmacists were jointly trained, a person was assigned as being responsible for the primary care teams (EAP) and support material was handed out. An initial evaluation was performed using computerised sentences from the Program data model in the electronic clinical notes, which showed much improvable results. Using quality tools, the causes of low coverage and insufficient results in the rest of the quality indicators were identified and corrective actions were introduced to subsequently monitor and re-assess the program. RESULTS: Evaluation of the indicators included in the program. Initial data analysis (February 2007): cover, 3.5% (361 users included); treatment review (RT), 2.1%; review of medication use (RU), 51.2%; assessment of knowledge of the medication (CM), 84.8%; Morisky test (TM), 57.6%; offer of personal dispensing system (SPD), 57.1%; treatment evaluation (VT), 50.1%; care plans (PC), 19.2%; beers criteria (CB), 14.9%. After introducing the improvement actions, the following results were obtained in December 2007: cover, 131.8% (12,650 users); RT, 80.6%; RU, 62.7%; CM, 92.4%; TM, 9.3; SPD, 67.3%; VT, 61.6%; PC, 27.59%, and CB, 13.6%. CONCLUSIONS: The introduction of an institutional program, the involvement of the management of Area 4, the application of appropriate quality tools, the continuous monitoring of quality indicators and giving this information back to the professionals has enabled, ten months after the corrective measures were introduced, the institutional objectives of coverage to be achieved. It has also significantly improved quality care activities and their recording, achieving the best results for coverage and quality health care in the Community of Madrid program.

Implantación y mejora de un programa de atención al mayor polimedicado en un área de atención primaria / Introduction and improvement of a care program for the elderly on multiple medication in a primary care area

Introducción: El propósito de este estudio es describir la implantación del Programa de Atención al Mayor Polimedicado, impulsado por la Dirección General de Farmacia de la Comunidad de Madrid, en un área de atención primaria y el ciclo completo de mejora con sus resultados tras la evaluación inicial. Métodos: El programa, dirigido a mayores de 75 años que consumen 6 o más principios activos (9.721 personas en el área al inicio del programa), comienza en septiembre de 2006. Se basa en la coordinación con las oficinas de farmacia, la revisión sistemática del tratamiento, la educación sanitaria y la entrega de sistemas personales de dosificación para el correcto uso de la medicación. Para su implantación en el área se formó a todos los profesionales y a los farmacéuticos de las oficinas de farmacia conjuntamente, se nombró responsables en los equipos de atención primaria (EAP) y se repartió material de ayuda. Se realizó una evaluación inicial mediante sentencias informatizadas del modelo de datos del programa en la historia clínica electrónica, que mostraba resultados muy mejorables. Mediante herramientas de calidad se identificaron las causas de la escasa cobertura y los resultados insuficientes en el resto de los indicadores de calidad en la atención y se procedió a implementar las acciones correctivas para, posteriormente, monitorizar y reevaluar el programa. Resultados: Evaluación de los indicadores incluidos en el programa. Primer análisis de datos (febrero de 2007): cobertura del 3,5% (361 usuarios incluidos); revisión del tratamiento (RT), 2,1%; revisión del uso de fármacos (RU), 51,2%; valoración del conocimiento sobre medicación (CM), 84,8%; test de Morisky (TM), 57,6%; propuesta de sistema personal dosificación (SPD), 57,1%; valoración del tratamiento (VT), 50,1%; planes de cuidados (PC), 19,2%; criterios de Beers (CB), 14,9%. En diciembre de 2007, tras la implantación de las acciones de mejora, se obtienen los siguientes resultados: cobertura, 131,8% (12.650 usuarios); RT, 80,6%; RU, 62,7%; CM, 92,4%; TM, 9,3; SPD, 67,3%; VT, 61,6%; PC, 27,59%; CB, 13,6%. Conclusiones: La implantación de un programa institucional, la implicación de la Dirección Gerencial del Área 4, la aplicación de las herramientas de calidad adecuadas, la monitorización continua de los indicadores y la devolución de la información a los profesionales han permitido que, 10 meses después de implantar las medidas correctoras, se superen los objetivos institucionales de cobertura y mejoren significativamente las actividades de buena atención y su registro, con lo que se obtienen los mejores resultados de captación y de calidad asistencial del programa de la Comunidad de Madrid

Background: The purpose is to describe the introduction of a Care Program for the Elderly on Multiple Medication in a Primary Care area and the complete improvement cycle after evaluating the initial results The Program was instigated by the Community of Madrid Pharmacy Directorate. Methods: The Program was aimed at patients over 75 years who took 6 or more active ingredients (9721 patients in the area at the start of the program) and began in September 2006. It is based on coordinating with pharmacists, systematic review of treatment, health education, and the providing of personal dose dispensing systems for the correct use of the medication. Before its introduction, all the health professionals and pharmacists were jointly trained, a person was assigned as being responsible for the primary care teams (EAP) and support material was handed out. An initial evaluation was performed using computerised sentences from the Program data model in the electronic clinical notes, which showed much improvable results. Using quality tools, the causes of low coverage and insufficient results in the rest of the quality indicators were identified and corrective actions were introduced to subsequently monitor and reassess the program. Results: Evaluation of the indicators included in the program. Initial data analysis (February 2007): cover, 3.5% (361 users included); treatment review (RT), 2.1%; review of medication use (RU), 51.2%; assessment of knowledge of the medication (CM), 84.8%; Morisky test (TM), 57.6%; offer of personal dispensing system (SPD), 57.1%; treatment evaluation (VT), 50.1%; care plans (PC), 19.2%; beers criteria (CB), 14.9%. After introducing the improvement actions, the following results were obtained in December 2007: cover, 131.8% (12,650 users); RT, 80.6%; RU, 62.7%; CM, 92.4%; TM, 9.3; SPD, 67.3%; VT, 61.6%; PC, 27.59%, and CB, 13.6%. Conclusions: The introduction of an institutional program, the involvement of the management of Area 4, the application of appropriate quality tools, the continuous monitoring of quality indicators and giving this information back to the professionals has enabled, ten months after the corrective measures were introduced, the institutional objectives of coverage to be achieved. It has also significantly improved quality care activities and their recording, achieving the best results for coverage and quality health care in the Community of Madrid program

Mejora de la seguridad y evaluación de los resultados del proceso de anticoagulación oral implantado en un área de atención primaria / No disponible

Objetivo: Describir la mejora de la seguridad del proceso de atención a pacientes con tratamiento de anticoagulación oral (TAO), implantadoen el Área 4 de Atención Primaria (AP) de Madrid, y evaluar los resultados sobre el control y el seguimiento de dichos pacientes después de 1 año de su implantación.Material y método: El trabajo se articula como proyecto de mejora en 3 fases: a) análisis de debilidades, amenazas, fortalezas y oportunidades(DAFO) tras 1 año de implantación del proceso; b) aplicación de la metodología análisis modal de fallos y efectos (AMFE), y c) evaluación de la implantación, el control y el seguimiento de los pacientescon TAO. La obtención de los datos de los pacientes se realizó a través de una explotación específica de los protocolos de seguimiento TAO de la historia clínica informatizada (HCI) OMI-AP. Se incluyó a todos los pacientes anticoagulados seguidos en AP en elaño 2006, con registro en el protocolo específico TAO informatizado. Resultados: La aplicación de la metodología AMFE, bastante novedosaen AP, ha supuesto identificar los fallos críticos priorizados por el índice de priorización del riesgo (IPR); la puntuación del IPR oscilóentre 8 y 343. Igualmente el AMFE nos ha servido para la introducción de acciones de mejora y la elaboración de los indicadores que nos sirven para monitorizar todo el proceso. Los resultados de la primera evaluación indican que el programa está implantado en el 100% de los equipos. El número de pacientes incluidos en el servicioen 2006 fue de 3.013, lo que supone una cobertura del 59,8%. En cuanto al sexo, el 54,2% de los pacientes seguidos (1.633) son mujeres, el 43% (1.305) son varones y hay un 2,5% (75) no registrado. La media de edad es de 75 años. En cuanto a las indicaciones, fibrilación auricular/arritmias cardíacas es la primera causa conun 61% del total. El valor medio de INR ha sido 2,5. La media de determinaciones por paciente: 12,8. Los valores de INR en rango terapéutico son 20.581 (53%) y en rango ajustado a + 0,2 (posible error del coagulómetro) los valores aumentan hasta el 66%. El porcentajede días que permanecen los valores en rango ha sido del68%, y si lo ajustamos al + 0,2%, ascienden al 79% de los días. Solamente encontramos a 13 pacientes con efectos adversos. Conclusiones: La aplicación del AMFE ha supuesto una mejora importantede todo el proceso, fundamentalmente desde el punto de vista de la seguridad, así como la elaboración de unos indicadores de seguimiento.Este estudio aporta resultados sobre el seguimiento de todos los pacientes con TAO, sin necesidad de muestreo, después de 1 año de su implantación, que nos revelan en general su buen control clínico y la aceptación de los profesionales en la realización del nuevo servicio

Objective: To describe improvements in the safety of the management of patients under oral anticoagulation therapy (OAT) implemented in Primary Care Area 4 of Madrid, Spain, and evaluate the results of monitoring of these patients 1-year after implementation.Material and method: The project was developed in three phases: a) Analysis of strengths, weaknesses, opportunities and threats (SWOT) 1 year after implementation of the program; b) Applicationof a failure modes and effects analysis (FMEA), and c) Evaluation of the implementation, monitoring and follow-up of patients receiving OAT. Data were gathered through exportation of the OAT follow-up protocols of the computerized medical records of the computerizedmedical office for primary care (Oficina Médica Informatizada para Atención Primaria [OMI-AP]) program.Results: Application of the FMEA methodology, which is fairly novel in primary care, identified the critical failures prioritized by the Risk Prioritization Number (RPN); the RPN ranged from 8 to 343. FMEA was also useful for the introduction of improvementinterventions and the design of indicators to be used in monitoring the entire process. The results of the first evaluation indicate that the program was implanted in 100% of the teams. The number of patients included in the service in 2006 was 3,013, representing a coverage of 59.8%. A total of 54.2% (1,633) of the patients followed-up were women, 43% (1,305) were menand 2.5% (75) were not registered. The mean age was 75 years. The main indication for OAT was atrial fibrillation/cardiac arrhythmia, accounting for 61% of the total. The mean internationalnormalized ratio (INR) was 2.5. The mean number of determinations per patient was 12.8. There were 20,581 (53%) INR values in the therapeutic range and in the range adjusted to + 0.2 (possible error of the coagulometer), these values increasedto 66%. The percentage of days in which values remained in the range was 68% and when adjusted to + 0.2%, this percentage reached 79% of the days. Only 13 patients experienced adverse effects. Conclusions: Application of FMEA methodology substantially improvedthe entire process, especially safety and the design of follow-up indicators. The present study reports the results on the follow-up of all patients with OAT, without the need for sampling, 1 year after implementation. In general, these results show good clinical management and health professionals’ acceptance of carrying out the new service