Barriers to Warfarin Use for Stroke Prevention in Patients With Atrial Fibrillation in Hong Kong

Abstract

Background:Oral anticoagulation medications such as warfarin reduce the risk of stroke in atrial fibrillation (AF) but have been underutilized. This study aimed to investigate physicians' perceptions of stroke prevention management and patients' knowledge of AF and warfarin therapy in Hong Kong (HK).Hypothesis:Both physician and patient's knowledge on warfarin use were the barriers for stroke prevention in patients with atrial fibrillation in Hong Kong.Methods:This prospective survey‐based study was conducted between February 2011 and April 2011 to assess physicians' perceptions of stroke prevention management, patients' knowledge of AF, and patients' knowledge of warfarin therapy. The results were scored and compared with those in foreign countries.Results:Sixty‐two physicians and 114 warfarin users were recruited in the study. The average score of HK physicians in the knowledge of stroke prevention therapy in AF patients was lower than that of Australian (AUS) family physicians (HK 2.48 vs AUS 4.02 out of 7). The mean scores of AF patients in Hong Kong regarding the knowledge of AF were lower than that of United Kingdom (UK) (HK 1.16 vs UK 2.24 out of 4) (P < 0.001) and that of Finland (FIN) (HK 2.77 vs FIN 5.94 out of 8) (P < 0.001), respectively. The mean score of AF patients in Hong Kong regarding the knowledge of warfarin therapy was lower than that of AF patients in the United States (US) (HK 2.39 vs US 3.92).Conclusions:The barriers of warfarin use for AF patients in Hong Kong were related to both physicians and patients. Many Hong Kong physicians did not comply with international recommendations of stroke prevention in AF patients, and AF patients had a low knowledge level about the disease and warfarin therapy.Presented at the International Congress of Cardiology, Hong Kong, Peoples Republic of China, February 24‐26, 2012.This study was supported by the School of Pharmacy, the Chinese University of Hong Kong.The authors have no other funding, financial relationships, or conflicts of interest to disclose.

The use status of anticoagulation drugs for inpatients with nonvalvular atrial fibrillation in Southwest China

“…This study demonstrated that physician’s choice was the most important reason, followed by patient refusal. A large number of doctors lacked knowledge concerning the management of AF and knew less about anticoagulation therapy 20. Also, the majority of physicians feared the bleeding risk related to warfarin, which was likely to lead to conflicts between doctors and patients 21,22.…”

Long-Term Persistence of Newly Initiated Warfarin Therapy in Chinese Patients With Nonvalvular Atrial Fibrillation

“…8 However, warfarin is extremely underused 9,10 in Chinese patients with AF, particularly in those with a higher stroke risk. 11,12 Besides physicians' compliance with guideline recommendations for stroke prevention, 13 patients' nonadherence and nonpersistence to warfarin are major barriers to improved anticoagulation treatment in patients with AF.…”

Stroke and Bleeding Risk in Atrial Fibrillation: Navigating the Alphabet Soup of Risk‐Score Acronyms (CHADS2, CHA2DS2‐VASc, R2CHADS2, HAS‐BLED, ATRIA, and More)

“…There is a large number of stroke risk factors identified among AF patients; hence, an individual patient's risk will depend largely on the combination of risk factors, rather than from simply being an AF patient. Permutations of these risk factors have been used to formulate stroke risk‐stratification schemes, with the initial objective of identifying high‐risk patients to be targeted for OAC using an “inconvenient” drug, warfarin …”

“…Permutations of these risk factors have been used to formulate stroke risk-stratification schemes, with the initial objective of identifying high-risk patients to be targeted for OAC using an ''inconvenient'' drug, warfarin. 7,8 The derivation of stroke risk-stratification schemes depends on identification of common risk factors, which importantly have been defined and recorded in derivation 634 Clin. Cardiol.…”