Do you think that home INR monitoring is a feasible option for elderly, frail patients with atrial fibrillation on VKA treatment, given variations in socioeconomic status and access to care?

Whenever possible, I prescribe home INR monitoring with appropriate equipment. This allows me to monitor my patients on a weekly basis, rather than on a monthly basis at best. Unfortunately, insurance reimbursement is not standard for this equipment, and many patients are unable to obtain it. The ability to offer home visits for INR drawing is even more limited in this country. These limitations are not at play in European countries, whose patients afford better INR monitoring, either with a device or through social services. These considerations need to be kept in mind when selecting VKA versus DOACs in naive patients.

While home INR monitoring has revolutionized the use of VKA treatments, there are many patients who do not have access to this monitoring modality. In a population of frail, elderly patients, this may be due to lack of technical skills or clinical support in addition to access of care challenges. In my clinical practice, this is less effected by socioeconomic status than individual cognitive ability, familial support and general well-being.