Management of warfarin in atrial fibrillation: views of health professionals, older patients and their carers

Abstract

Objective: To identify the views of health professionals, patients and their carers on strategies to improve the use and management of warfarin in older patients with atrial fibrillation. Design: Qualitative study based on analysis of group interviews. Setting: A major metropolitan teaching hospital, from 1 March to 30 April 2003. Participants: 14 patients (у 65 years) with established atrial fibrillation and taking warfarin, three carers, 12 specialists, eight general practitioners, six community pharmacists, nine hospital pharmacists, and 11 nurses volunteered in response to flyers promoting the study. Results: Suggested strategies to improve warfarin management targeted support services for GPs and patients. Hospital-based clinicians felt that dissemination of trial evidence to GPs to support treatment recommendations is required, and that GPs need to enlist allied health professionals in the management of patients taking warfarin. GPs preferred access to practical advice from expert colleagues on the day-to-day management. Patients requested more information about warfarin therapy, as access to information is inadequate, particularly from primary sources (GPs, community pharmacists). Verbal and written information are equally important, but a single counselling session or supply of a booklet was viewed as inadequate. Participants identified various interventions for all levels of warfarin management; from the collective input, a framework for management strategies was developed. Conclusions: Health professionals and patients require more customised information MJA 2007; 186: 175-180 to support warfarin use and management.

Patients’ and physicians’ perceptions and attitudes about oral anticoagulation and atrial fibrillation: a qualitative systematic review

“…We also included a still unpublished study conducted by our group [37]. Two of the nine studies collected data both from patients and physicians [29, 37], four collected data from patients only [28, 32, 33, 35], and three from physicians only [31, 34, 36]. In four studies, the quality assessed was excellent [29–31, 35, 37] and in five was moderate [28, 32–34, 36].…”

“…The five studies with physicians as participants [29, 31, 34, 36, 37] (Table 1) included a total of 91 physicians (family physicians, cardiologists, geriatrics and internal medicine physicians). The three main themes that emerged from the analysis were: I) information to reinforce anticoagulation use; II) balance of benefits and downsides; and III) roles in decision-making and therapy management (Fig.…”

“…The information needed to reinforce the vitamin K antagonists (VKAs) use was a theme that emerged in all five studies including physicians as participants [29, 31, 34, 36, 37]. …”

“…Thematic analysis (information through email). Grounded theory.excellent-Patients2112 men/9 womenBajorek et al 2007, 2009 [29, 30]AustraliaQualitative: PhenomenologyFocus groupsThematic analysisexcellent-Physicians2012 men/8 women[Geriatricians, Cardiologists, General medicine (consultants or registrars),General Practice]-Nurses-Pharmacist(6 Geriatric6 Cardiologists/General Medicine8 General Practice)-Patients14-CarersSolà et al 2009 [37]SpainMixed: quantitative and qualitativeFocus groupsContent analysisexcellentPhysicians[General Practice, Cardiologists and Internal Medicine]23 (15 General Practice, 5 Cardiologist, 3 Internal Medicine)12 men/11 womenPatients2315 men/8 womenLipman et al 2004 [29]United KingdomQualitativeSemi-structured Interview.Framework methodexcellent-Physicians[General Practices with an active interest in research or evidence-based medicine]119 men/2 womenAnderson et al 2006 [34]United KingdomMixed: quantitative and qualitativeQuestionnaire and semi-structured interviewInterpretative. Grounded theory.moderate-Physicians14[Cardiologists, Geriatric or general medicine (consultants or Specialist Registrars)]5 Cardiologists,9 Geriatric or General medicineDecker et al 2012 [36]United StatesQualitativeSemi-structured Interview.Content analysismoderate-Physicians[Cardiologists and internal medicine)-Nurses practioner23(18 Cardiologist5 Internal Medicine) …”

Validation of the Risk Estimator Decision Aid for Atrial Fibrillation (RED-AF) for Predicting 30-Day Adverse Events in Emergency Department Patients With Atrial Fibrillation

“…AF patients desire increased knowledge of their disease, more discussion regarding the risks and benefits of treatment options, and increased engagement in management decisions. [34–37] We believe that educating patients about their short term risk for complications related to their AF, the risk of potential hospital associated complications, [38, 39] and including patients and their caregivers in a shared decision making process on the most appropriate ED disposition using validated decision support tools such as RED-AF will safely reduce total AF hospital days, 30-day readmissions, and improve patient quality of life. [36]…”