A total of 124 patients were admitted with a primary diagnosis of exacerbation of CHF or COPD during the study period (Table 1). Of these, 67 were excluded, most because of active anticoagulation before or at the time of admission to hospital. The demographic characteristics and risk factors of the 57 patients included in the study are reported in Table 2. The baseline characteristics of the patients with CHF were similar to those of the patients with COPD.
Table 1. Characteristics of Patients Included in and Excluded from Study
Table 2. Demographic Characteristics of 57 Patients Included in Study
During the study period, which followed the educational intervention, 13 (46%) of the 28 patients with CHF exacerbations and 10 (30%) of the 33 patients with COPD exacerbations received VTE prophylaxis. The poor rate of prophylaxis, despite the educational intervention (Table 3), prompted the survey of physicians, described above. Of the 285 surveys that were mailed, 46 (16%) were returned. Most respondents attributed the low rate of prophylaxis to oversight and lack of awareness of current guidelines and indications (Table 4).
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Table 3. Use of VTE Prophylaxis before and after Educational Intervention
No. (%) of Patients Receiving LDUH or LMWHi n Accordance with Guidelines
CHF COPD All patients
Initial audit (April 1, 1999, to March 31, 2000) 29/155 (19) 37/110 (34) 66/265 (25)
Table 4. Perceived Barriers to VTE Prophylaxis (n = 46)