IJCS | Volume 31, Nº4, July / August 2018

389 Borges et al. Adherence score Int J Cardiovasc Sci. 2018;31(4)383-392 Original Article of its half-life and pharmacological effect. In this case, a higher dose of warfarin is recommended to reach the therapeutic range. 10 In addition, psychological distress has been associated with a prothrombotic state. In patients with diagnosis of thromboembolism, decreased INR was associated with psychological distress, anger, depression and anxiety. 11,12 To minimize the risk of OAC-related complications, such as bleeding and thromboembolic events, the emergence of specialized clinics for the management of patients on OAC-T has become a common scenario worldwide. Besides, health professionals including pharmacists, nurses and physicians are responsible for implementing educational programs with oral and written instructions, videos, home visits, telephone follow-up and quality control indicators. 6 In this perspective, predisposing factors related to oral anticoagulant therapy as continuous use in treatment of thromboembolic diseases and cardiac valvar prosthesis have to be studied. Mundial recommendations are relevant and published by of the American Heart Association 13 and European Society of Cardiology. 14 ​ Considering this assumption and the necessity to develop a medication adherence score for users of OACs, we adopted a complex, well-articulated and decisive methodological approach. This included the selection of predictive variables based on the clinical practice and also on researcher’s opinion, determined by practice-based evidence and current science. Variables with statistical significance lower than 5% were selected for multiple logistic regression analysis, with adjustment for determinant factors and covariables of adherence. Variables related to adherence were then independently determined. For adherence score development, variables known to affect INR were considered, including inadequate Figure 3 - Areas under the ROC (Receiver Operating Characteristic) curves for medication adherence by the Simonetti score. Sensitivity 1- Specificity Probability of the model Score Reference line ROC curves