Stroke risk reassessment and oral anticoagulant initiation in primary care patients with atrial fibrillation: A ten‐year follow‐up

Abstract

Aim: To examine the change in stroke risk over time and determine the proportion of patients with atrial fibrillation (AF) who were initiated on an oral anticoagulant (OAC) as their stroke risk increased from low/moderate to high, using the Australian general practice data set, MedicineInsight.

Use of thromboprophylaxis guidelines and risk stratification tools in atrial fibrillation: A survey of general practitioners in Australia

“…Further, the patient factors most strongly influencing GPs' prescribing decisions were stroke and bleeding risk, older age and history of ICH. Identifying GPs' sources of prescribing information and their decision‐making process could support efforts to improve guideline usability so that non‐guideline‐adherent OAC prescribing and inconsistent thromboprophylaxis in AF is reduced in Australian general practice 11,12 . Saying this, we acknowledge that prescribers may appropriately deviate from guideline‐recommended therapy in the interests of person‐centred care, because of individual clinical contexts and the patients' goals of therapy 16,26 .…”

“…Recent data from the Australian general practice setting indicated that one‐third of patients whose stroke risk changed from low‐to‐moderate to high were not prescribed OAC therapy. In the remaining patients who received OAC therapy, OAC initiation was reported to be delayed by a median of 2 years, which suggested a need for more frequent stroke risk reassessments 12 . This is also true with bleeding risk reassessments.…”

“…Identifying GPs' sources of prescribing information and their decision-making process could support efforts to improve guideline usability so that non-guidelineadherent OAC prescribing and inconsistent thromboprophylaxis in AF is reduced in Australian general practice. 11,12 Saying this, we acknowledge that prescribers may appropriately deviate from guideline-recommended therapy in the interests of person-centred care, because of individual clinical contexts and the patients' goals of therapy. 16,26 Documentation of such decisions, for instance with the help of electronic decision supports, could help differentiate situations where patients with AF may benefit from guidelineadherent therapy from those where deviations from guideline recommendations are more appropriate.…”

“…However, deviations from these recommendations, primarily undertreatment, are observed 8 . Recent Australian studies have reported that 19%–37% of hospitalised AF patients at high risk of stroke did not receive OAC therapy, 9,10 while the rate of nonprescribing in high‐risk patients in general practices has been reported at 35%–45% 11,12 …”

“…8 Recent Australian studies have reported that 19%-37% of hospitalised AF patients at high risk of stroke did not receive OAC therapy, 9,10 while the rate of nonprescribing in high-risk patients in general practices has been reported at 35%-45%. 11,12 Several factors contribute to OAC undertreatment in AF. Most of the previous studies that reported factors associated with thromboprophylaxis undertreatment in AF were based on findings from retrospective studies and largely outside of the general practice setting.…”