Physicians’ Perceptions of Their Patients’ Attitude and Knowledge of Long-Term Oral Anticoagulant Therapy in Bulgaria

Abstract

Background and Objectives: Oral anticoagulation (OAC) is widely used in daily clinical practice worldwide for various indications. We aimed to explore the perception of Bulgarian clinicians about their patients’ attitude and knowledge of long-term OAC, prescribed for atrial fibrillation (AF) and/or known deep venous thrombosis (DVT)/pulmonary embolism (PE). Materials and Methods: We performed a cross-sectional study that involved 226 specialists: 187 (82.7%) cardiologists, 23 (10.2%) neurologists, and 16 (7.1%) vascular surgeons. They filled in a questionnaire, specially designed for our study, answering various questions regarding OAC treatment in their daily clinical practice. Results: The mean prescription rate of OACs in AF patients was 80.3% and in DVT/PE—88.6%. One hundred and eighty-seven (82.7%) of the participants stated they see their patients on OAC at least once per month. According to more than one-third of the inquired clinicians, the patients did not understand well enough the provided information concerning net clinical benefit of OAC treatment. About 68% of the clinicians declared that their patients would prefer a “mutual” approach, discussing with the physician the OAC options and taking together the final decision, whereas according to 43 (19.0%), the patients preferred the physician to take a decision for them. Patients’ OAC treatment had been interrupted at least once within the last year due to a physician’s decision by 178 (78.8%) of the participants and the most common reason was elective surgery. The most influential factors for a patient’s choice of OAC were the need of a specific diet to be kept, intake frequency, and possible adverse reactions. Conclusions: Our results suggest that a clinician’s continuous medical education, shared decision-making, and appropriate local strategies for improved awareness of AF/DVT/PE patients are key factors for improvement of OAC management.

Neurology care and the long-term outcomes of atrial fibrillation-related ischaemic stroke in China: median 3-year outcome from a high volume academic tertiary hospital

“…Meanwhile, patients with higher educational levels and more knowledge about OACs might be more compliant with anticoagulation therapy 27. Educational interventions on patients, either by educational videos or doctors,28 could improve OAC management and patient adherence 29…”

“…27 Educational interventions on patients, either by educational videos or doctors, 28 could improve OAC management and patient adherence. 29 Through all the efforts for a decade, the OAC use has been improved. The overall anticoagulation rate in patients with previous strokes at discharge from early studies in China was 19.4%, 9 but increased to 53.66% in our study.…”

Anticoagulation in Atrial Fibrillation Patients

“…French patients preferred the physician to select AF therapy, while German, US, and Canadian patients preferred to be involved in therapeutic choices [96]. A cross-sectional survey of 226 physician specialists in Bulgaria also reports that 68% of patients who have an indication for anticoagulation therapy preferred a shared decision-making approach, and only 19% wanted the physician to make all anticoagulation therapy choices [97]. Improved understanding about the risk of stroke, the nature of stroke, and anticoagulation treatment may improve adherence and empower patients in their own care.…”