Heart diseases can be expected to increase in the coming years. The epidemic of overweight and obese individuals alone promises that outcome. As a result, more and more people with chronic heart problems will be taking more medicine in an attempt to control their condition. A study by Fritschi and colleagues noted that the need for oral anticoagulation has grown in recent years. The treatment requires frequent monitoring of the prothrombin time to keep the intensity within the therapeutic range and to minimize the risk for complications. Patient self-management has been found to improve the taking of the drug and, in turn, the quality of the medication. The study investigated the first 330 patients performing self-management for the anticoagulant in Switzerland. A questionnaire was sent to all patients who followed a teaching program for self-management for heart disease between 1998 and 2003. Physicians were contacted and/or discharge letters were obtained from the hospitals or the treating physicians. Out of the 300 patients providing information 254 still perform self-management skills. At least one prothrombin determination per two weeks was done by 74% of the patients and 25% performed at least one measurement every 15-30 days. No thromboembolic complications occurred among the 13 patients who died during the study. When counting these events as arterial thromboembolic complications the frequency was 0.6 per 100 patient-years. The frequency of major bleeding was 0.6 per 100 patient-years.

COMMENTS: The authors concluded that self-management was suitable and safe for participants trained to perform the skills required taking heart disease medications. The findings are similar to other studies that reported the success of self-monitoring in controlling other chronic illnesses, such as diabetes, asthma, and high blood pressure. As self-management works, it is time for all patients with a chronic illness that requires close monitoring to learn how to take responsibility for these actions.

J. Fritschi et al. Patient self-management of long-term oral anticoagulation in Switzerland. Swiss Medical Weekly, 2007;137:252-258.