SummaryBackground Uptake of self-testing and self-management of oral anticoagulation has remained inconsistent, despite good evidence of their eff ectiveness. To clarify the value of self-monitoring of oral anticoagulation, we did a metaanalysis of individual patient data addressing several important gaps in the evidence, including an estimate of the eff ect on time to death, fi rst major haemorrhage, and thromboembolism.

Management of oral anticoagulation by INR self-management in patients with atrial fibrillation is not inferior to conventional care.

In this study, the cost-effectiveness of anticoagulation self-management--which is now established in Germany--was compared with the conventional method of monitoring oral anticoagulant therapy by the patient's family physician or by a specialist. Costs were determined based on the usual conditions in Germany such as frequency of testing and control testing, scope of the tests, and diagnostic and therapeutic standards for thromboembolic or bleeding complications. In addition to direct monitoring costs, we determined the costs for treating minor and serious complications and used them to calculate overall therapy costs. The incidence of complications was estimated based on the results of more recent studies. The only costs considered in this study were those covered by the primary cost carrier--the government-controlled health insurance funds--and included outpatient visits and, in cases of serious complications, acute inpatient treatment and rehabilitation. It was shown that the costs to treat minor complications only slightly affected annual, overall treatment costs. The potential reduction in incidences of serious bleeding and thromboembolic complications due to anticoagulation self-management--which is independent of the indication for oral anticoagulation--reduced overall therapy costs from DM 2,061.48/patient-year for conventional therapeutic methods to DM 1,342.46/patient-year for patients under self-management of anticoagulation.

Objective: Physical activity is crucial in the treatment of cardiac disease. In addition to sociocognitive theories of behavior change, attitudinal ambivalence and nonconscious factors have also been demonstrated to predict physical activity. We propose an extension to the theory of planned behavior with a dual-systems approach including explicit and implicit attitudes, and different types of attitudinal ambivalence as moderators to predict the physical activity of patients after discharge from inpatient cardiac rehabilitation. Method: The sample comprised N = 111 cardiac patients who provided daily diary reports of intention, cognitive, affective, and implicit attitudes for 21 days after discharge (86% male, M age = 62, SD age = 11, n = 2,017 days). Daily moderate-to-vigorous (MVPA) and light (LPA) physical activity were measured using accelerometers. Five types of ambivalence were calculated. Analyses included Bayesian multilevel modeling. Results: Patients with more positive affective attitudes and more positive implicit attitudes had a higher intention. Higher ambivalence weakened the affective attitudes-intention relationship. On days with more positive implicit attitudes than usual, intention was lower, but only when ambivalence was low. Patients with higher ambivalence engaged in less MVPA. On days with extremely low ambivalence, implicit attitudes were negatively associated with tomorrow's MVPA. Patients with more positive affective attitudes engaged in more LPA, but only when their ambivalence was very low. On days with higher ambivalence than usual, the next day's LPA was shorter. However, another type of ambivalence showed the opposite effect. Conclusions: The results emphasize the importance of affective and implicit attitudes and ambivalence for the physical activity of cardiac patients.

Despite overwhelming evidence of the benefits of risk-adjusted oral anticoagulation on stroke reduction in patients with atrial fibrillation (AF), there is still considerable undertreatment. A multidisciplinary expert group was formed to discuss issues surrounding anticoagulant treatment of patients with AF to try and achieve consensus on various aspects of the implementation of guidelines on oral anticoagulation therapy in AF. Panel members were cardiologists, hematologists, and laboratory and primary care physicians with specific expertise from Europe and the United States. One of the most important conclusions of the meeting was to enhance guideline adherence by better communication of the data showing that the benefits of stroke reduction outweigh the risk of bleeding associated with treatment with vitamin K antagonists. Management of oral anticoagulation therapy by dedicated centers, such as anticoagulation clinics, or by patient self-management may improve the quality of anticoagulation and facilitate the management of these patients and thereby further facilitate optimal antithrombotic management in patients with AF.