Continuing heart, blood pressure and anticoagulant care in Spain

Key rules

• Family doctor: Your family doctor is the route to cardiology, INR monitoring and repeat prescriptions.
• INR location: Whether INR is checked at a hospital clinic or a health centre depends on your region and area.
• Previous report: Bring a report from your previous prescriber with the reason for anticoagulation, target INR range and dose.
• DOAC authorisation: The national prior-authorisation requirement for newer anticoagulants was removed in 2022, though some regions may keep their own controls.
• Emergencies: Sudden heart symptoms go to urgencias, not a routine appointment.

Start with your family doctor

Your family doctor (médico de familia) is the door to almost everything here. Once you are registered in the public health system, book an appointment and bring your previous records and a medication list.

Your family doctor and nurse handle high blood pressure: checks, home or 24-hour monitoring, blood tests and changes to your medication. They also refer you to hospital cardiology.

Heart care and cardiology

You do not book a cardiologist yourself. Your family doctor refers you if there is suspected heart disease, heart failure, an arrhythmia, blood pressure that resists treatment or has a specific underlying cause, or an abnormal ECG or symptoms.

After referral, cardiology sets your review appointments. When you are stable, they usually send you back to your family doctor. Waiting times and local protocols vary by region.

For sudden heart symptoms, go to urgencias. Do not wait for a routine appointment.

INR monitoring (acenocoumarol or warfarin)

If you take acenocoumarol (Sintrom) or warfarin, INR checks are done in one of two places. Some areas use a hospital haematology anticoagulation clinic. Others use your health centre, often with a finger-prick test and a nurse running it. Which one applies depends on your region and health area, so ask your family doctor.

Your family doctor either refers you to the local unit or takes you on directly. Bring a report from your previous prescriber with the reason for anticoagulation, your target INR range and your current dose. Without it, the new team has to guess your starting point.

Self-testing at home is offered in some regions, including Catalonia, the Basque Country, Madrid, Andalusia and Valencia. Programmes train selected patients, and some supply meters or strips. Others only fund checks at the health centre or pharmacy. Eligibility and funding vary by region and hospital, so ask your haematology unit or health centre before you buy a meter.

Newer anticoagulants (DOACs)

Newer anticoagulants (dabigatran, rivaroxaban, apixaban, edoxban) are called DOACs. For atrial fibrillation, a specialist usually starts them. That can be cardiology, haematology, neurology or internal medicine. In some regions the family doctor can start them under local protocols.

Your family doctor normally renews the prescription through electronic prescription (receta electrónica). They review your kidney function and dose from time to time.

The national prior-authorisation requirement (visado) was removed in 2022, though some regions may keep their own controls. Ask your family doctor whether your region applies any.

Who does what

The decision, checklist and FAQ below take you through choosing where to do INR checks and what to ask for.

Choosing between options

Where should you have your INR checked?

• Hospital anticoagulation clinic: Your area runs INR monitoring through hospital haematology, and your family doctor refers you there.

• Your health centre: Your area uses primary care with nurse-led or point-of-care testing, and your family doctor takes you on directly.

Your family doctor enrols you in whichever model your region and health area use. Ask for self-testing only if your region has a programme, and check who supplies meters and strips.

Self-testing programmes change and vary by region and hospital; confirm with your haematology unit before buying equipment.

Checklist

• Book an appointment with your family doctor to take over blood pressure and heart follow-up.

• Ask your family doctor for a referral to hospital cardiology if you have heart disease, heart failure, an arrhythmia, hard-to-control blood pressure or an abnormal ECG.

• Ask your family doctor whether INR checks in your area are done at the health centre or at a hospital anticoagulation clinic, and get enrolled.

• Ask your haematology unit or health centre whether your region offers INR self-testing and whether strips are funded.

• Go to urgencias if you have sudden heart symptoms; do not wait for a routine appointment.

Frequently asked questions

Who renews my DOAC anticoagulant prescription in Spain?

Your family doctor normally renews a DOAC through electronic prescription (receta electrónica). A specialist or the family doctor starts the treatment, depending on regional protocols. Expect periodic reviews of your kidney function and dose.

Can I test my own INR at home in Spain?

Only in some regions, and only if you are selected for a programme. Catalonia, the Basque Country, Madrid, Andalusia and Valencia have programmes that train selected patients, and some supply meters or strips. Ask your haematology unit or health centre about eligibility and who pays for strips.

What should I bring so my INR monitoring can continue in Spain?

Bring a report from your previous prescriber with the reason for treatment, your target INR range and your current dose. Your family doctor uses it to refer you to the local unit or take you on directly.