At H me Provided by Roche Insulin Delivery Systems, Inc. Issue 1 June 2012 with CoaguChekT Patient Services Welcome to your first issue of At Home As dedicated partners in your healthcare, the entire staff at CoaguChekT Patient Services is committed to keeping you informed about issues that affect patients on warfarin therapy. This newsletter is one way we hope to demonstrate that commitment. Why do doctors prescribe different frequencies for PT/INR testing? Some people who take warfarin test their PT/ INR every other week, while some test it only once a month. Others might perform a PT/INR test every week. Why don’t doctors prescribe the same frequency for all patients? Because there’s no one-size-fits-all testing schedule that’s ideal for all patients. Physicians agree, however, that helping to keep their patients in target range as much as possible is a good thing. Why? Because staying in target range means patients have a lower risk of experiencing complications.1 And research shows a direct connection between frequent PT/INR testing and longer time in target range.2 (continued on pg. 2) We also invite you to contribute! You’re encouraged to tell us your story, or send us your questions about PT/ INR self-testing, CoaguChek products, or any other topic related to warfarin therapy. Then watch for information and answers in future issues. In the meantime, make yourself At Home. All the best, At Home Editor www.coaguchekathome.com AT HOME with CoaguChek Patient Services For example, in a study published in 1998, patients who self-tested every four days stayed in their target range 89% of the time— compared with physician-managed patients, who were tested every 19 days and stayed in range only 59% of the time.3 Later studies, some of which included different patient groups, such as those with mechanical heart valves and those being treated for atrial fibrillation, confirmed this connection (see graphic).4,5,6 In each study, the patients who tested more frequently (e.g., weekly) also stayed in their target PT/INR range significantly longer than those who tested less often (e.g., monthly). Research shows a direct connection between frequent PT/INR testing and longer time in target range.2 Private insurance coverage may vary when it comes to reimbursement for PT/INR self-testing. Medicare, however, covers up to four PT/INR tests per month.7 So is there an ideal test frequency? Is it once a month, every three weeks or once weekly? Only your physician can determine the right frequency for you. Whatever the answer, the ideal frequency is the one that provides you with the greatest peace of mind. This article is intended for educational purposes only. The information contained herein should not be used to make healthcare decisions, except by a qualified physician. Comparison of PT/INR test frequency and time in target range Testing every 4 days 1998 study3 Testing every 19 days 89% 59% Testing every 7 days 2001 study4 Testing every 30 days 78% 60% Testing every 7 days 2006 study5 Testing every 30 days 0 85% 50% 20 40 60 80 Percentage of time in range 100 Multiple studies show a direct connection between more frequent PT/INR testing and a greater percentage of time spent in target range. IN Response Q: C an I get future issues of the At Home with CoaguChek Patient Services newsletter via email? A: Yes, you can! Simply visit www.coaguchekathome.com and look for FREE Newsletter to sign up online. You can also submit your story ideas here, and, in the future, you’ll be able to review an archive of past issues of At Home with CoaguChek Patient Services. June 2012 Food for thought Popular supplements can pack lots of vitamin K in small packages If you use nutritional supplements even occasionally, it may be more difficult to ensure that you’re getting a consistent level of vitamin K, which can affect your body’s response to warfarin. Whether these products come in chewable tablets, nutrition bars, liquids or shakes, they can pack a lot of vitamin K into a small package. That’s why the Agency for Healthcare Research and Quality urges patients who take warfarin to keep their doctors informed about their use of nutritional supplements.8 Even if you monitor your intake of vitamin K-rich foods, you might be surprised to learn how much vitamin K is found in many nutritional supplements. For instance, two VIACTIVT Soft Calcium Chews contain 100% of the recommended daily allowance (RDA) of vitamin K.9 Two eight-ounce BoostT drinks contain 80% of the RDA for vitamin K.10 Consuming both products in these quantities in one day could exceed the normal RDA of vitamin K—and possibly influence warfarin dosing. The key is consistency when it comes to daily intake of vitamin K. So there’s no reason why you can’t use nutritional supplements as part of a healthy diet—especially if you do so on a regular basis. As with any dietary change, however, the decision to begin using supplements should be discussed with your doctor beforehand so your warfarin dose can be monitored more closely—and adjusted if needed. This article is intended for educational purposes only. The information contained herein should not be used to make healthcare decisions, except by a qualified physician. At your service News from your partners in care at CoaguChek Patient Services How do patients report their PT/INR results? 52% IVR Live person (phone) Web 11% 37% Nearly two-thirds of patients have already discovered a way to automatically make reporting their PT/INR results a fast and easy process. For 52% of them, the secret is using our automated Interactive Voice Response (IVR) system. Simple prompts help callers enter information quickly. Another 11% enter their results online at www.coagucheklink.com. Want to try the convenience of reporting your results (and quickly reordering supplies) online? It’s easy to set up an account by calling 800-780-0675 for a user name and password. A fun way to test your knowledge Across 1. Gumbo vegetable 5. A CoaguChek meter lets you self8. Kind of test (see 5 across) 9.Mother 10. Egyptian sun god 12. Phone service provider 13. Dorothy’s aunt 14. Shoot for 15.“ be, or not…” 16. Granite State (abbrev.) 17. Curve part (geometry) 18. XS meter 21.Source 22. Monet’s tools 26. PT/INR test time (2 words) 30. Bagel pal 31. Take action 32. Land of Opportunity State (abbrev.) 33.Peculiar 34.Exist 35. FBI’s latest tech tricks to ID people 36. Masculine pronoun 37. Alphabet’s conclusion 38. Completely consume (2 words) 40. Flower by any other name 41. One location option for placing a blood drop on a CoaguChek test strip Down 1. Film director Mr. Preminger 2. Frontiersman Mr. Carson 3.Nurse 4. Out-of-date word/phrase 5. Newsman Mr. Brokaw 1 8 2 3 4 12 15 X 7 10 14 16 X 11 X 17 18 21 6 13 19 20 X X 22 X 26 27 30 X 33 X 36 X 40 28 X Roche Diagnostics 9115 Hague Road Indianapolis IN 46256 www.coaguchekpatientservices.com COAGUCHEK and AT HOME are trademarks of Roche. All other product names and trademarks are property of their respective owners. 23 24 25 29 31 32 34 37 X 6. Same as 13 across 7. or treat! 8. Outdoor living area 9. Entrée list 11. “I think, therefore I .” 14.“You My Sunshine” 16. Egg-y drink 17. ha! 18. NYSE abbrev for CIGNA Corp. 19. Variation of 3 down 20. Roman emperor 22. Another variation of 3 down 23. Airport code for Hilo, Hawaii Körtke H, Minami K, Breymann T, et al. INR self-management after mechanical heart valve replacement: ESCAT. Z Kardiol. 2001;90(6):118-124. Samsa GP, Matchar DB. Relationship between test frequency and outcomes of anticoagulation: a literature review and commentary with implications for the design of randomized trials of patient self-management. J Thromb Thrombolysis. 2000;9:283–292. Horstkotte D, Piper C, Wiemer M. Optimal frequency of patient monitoring and intensity of oral anticoagulation therapy in valvular heart disease. J Thromb Thrombolysis. 1998;5(suppl): 19–24. Körtke H, Körfer R. International normalized ratio self-management after mechanical heart valve replacement: is an early start advantageous? Ann Thorac Surg. 2001;72:44-48. © 2012 Roche. 573-51440-0612 5 9 Issue #1 June 2012 2 4 X AT HOME with CoaguChek Patient Services 1 3 35 38 39 41 24. Cornhusker State (abbrev.) 25. CoaguChek test 26. and wiser 27. Indicate agreement 28. Former spouse 29. “Pure” girl’s name of Spanish origin 32. Acute fever (archaic) 33. Buckeye State (abbrev.) 34.Farewell! 35. The Simpsons’ Mr. Flanders 37.CoaguChek meter 39. Affirmative, in Spanish Provided by Roche Insulin Delivery Systems, Inc. Heneghan C, Alonso-Coello P, Garcia-Alamino JM, et al. Selfmonitoring of oral anticoagulation: a systematic review and meta-analysis. Lancet. 2006;367:404-411. 6 Shalev V, Rogowski O, Shimron O, et al. The interval between prothrombin time tests and the quality of oral anticoagulants treatment in patients with chronic atrial fibrillation. Thromb Res. 2007;120(2):201-206. 7 Centers for Medicare & Medicaid Services. Decision Memo for Prothrombin Time (INR) Monitor for Home Anticoagulation Management (CAG-00087R). 8 Blood Thinner Pills: Your Guide to Using Them Safely. Agency for Healthcare Research and Quality, Rockville, MD. August 2010. Available at http://www.ahrq.gov/btpills.htm. Accessed March 14, 2012. 9 McNeil Nutritionals, LLC. VIACTIVT Calcium Soft Chews FAQs. Available at http://www.viactiv.com/faq-calc. Accessed March 14, 2012. 10 Nestlé S.A. BoostT Nutritional Drink: Nutrition Panel. Available at http://www.nestle-nutrition.com/Products/Product. aspx?ProductId=2c639ab5-1656-4302-bb12-7b20a4439ec6. Accessed March 14, 2012. 5 For answers, visit www.coaguchekathome.com. CrossChek