Introduction Although many clinical trials have demonstrated that anticoagulant therapy substantially reduces the risk of ischemic stroke in patients with atrial fibrillation (AF), some physicians are reluctant to use anticoagulants. We investigated attitudes of physicians in Japan toward anticoagulant therapy in chronic AF patients.Methods We conducted a survey at the annual meeting of the Japanese Society of General Medicine. We presented subject physicians with 8 vignettes of chronic AF patients and requested that they indicate their most favored choice of therapy from among 6 strategies including warfarin and aspirin.Results We distributed 209 questionnaires and received 139 replies (67% response rate). For all 8 vignettes presented, only 26% of the respondents preferred to use anticoagulant therapy in AF patients. Longer clinical experiences and responsibility at a teaching hospital were associated with negative attitude toward anticoagulant therapy, while experience of preventive therapy in patients with thromboembolism due to AF and strong influence of clinical trials of anticoagulant prophylaxis on their practice were associated with positive attitude toward the therapy. Among patient characteristics in the vignettes, a risk of thromboembolism was positively associated with preference for anticoagulant therapy, but an advanced age and a risk of bleeding complications were negatively associated with the preference for the therapy.Conclusions The physicians in Japan in this survey, especially those with longer clinical experiences or responsibility at a teaching hospital, have a negative attitude toward anticoagulant therapy in chronic AF patients. An advanced age and a risk of bleeding complications of patients are deterrent factors to the use of anticoagulant therapy.
IntroductionChronic atrial fibrillation (AF) is a common arrhythmia and increases in prevalence from approximately 2% in the population aged 60 to 69 years to 7% in 70 to 79 years (1). AF is an important risk factor for ischemic stroke and has been reported to increase its risk about 5-fold (1, 2). Several randomized clinical trials (RCTs) have shown that anticoagulant therapy decreases the incidence of thromboembolism by about 70% in patients with chronic AF (3-8). Consequently, most evidence-based guidelines recommend anticoagulant therapy for chronic AF patients requesting at the same time to be individualized according to each patient's risk for thromboembolism (9-11).However, anticoagulant therapy trends to be underutilized in chronic AF patients. In fact, only 21 to 60% of chronic AF patients were reportedly given anticoagulants in Western countries (12). Physicians' perceived risk of anticoagulant therapy, i.e., increased frequency of haemorrhagic complications and cumbersome monitoring of prothrombin time among others, seems to be responsible for the reluctance of physicians to undergo the therapy. Several cross-sectional
Physicians' Attitudes Toward Anticoagulant Therapy in Patients with Chronic Atrial FibrillationKenji M...
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