The Educational Needs of Clinicians Regarding Anticoagulation Therapy for Prevention of Thromboembolism and Stroke in Patients With Atrial Fibrillation

Abstract

The objective is to identify practice patterns and attitudes of and barriers faced by US physicians assessing thromboembolism/stroke risk and managing anticoagulation in atrial fibrillation (AF) to determine educational needs. Case-based surveys were used to assess practice patterns, guideline use, barriers, and attitudes; 51 cardiologists and 50 primary care physicians (PCPs) were surveyed. Most cardiologists use validated risk scoring systems to assess thromboembolism/stroke risk, and more than half of PCPs use clinical experience. Assessment of bleeding risk varied; more than half of respondents rely on clinical judgment or patient bleeding history. The most commonly used prophylactic agents are warfarin/another vitamin K antagonist (PCPs) or antiplatelet agents (cardiologists). Newer anticoagulants are used less frequently. Bleeding risk, need for frequent monitoring (vitamin K antagonists), and medication costs were the most significant barriers. Cardiologists and PCPs could benefit from education on validated scoring systems to assess risk of thromboembolism/stroke and bleeding in AF, on newly released AF guidelines, and on newer anticoagulants.

Patient perception of anticoagulant treatment for stroke prevention (RE-SONANCE study)

“…It is recognised that there is a need for improvement in educational strategies around OACs6 9; in order to anticoagulate patients successfully with AF at high risk for stroke and prevent further ischaemic stroke, physicians and patients need to understand fully the rationale behind OAC treatment. Physicians must be provided with evidence regarding which treatment option best suits their patients’ clinical presentation.…”

“…Including patients in their treatment decision-making is important,3 and using educational intervention programmes targeting both patients and physicians can improve the use of OACs in patients with AF at risk of stroke 5–9. Evaluating patients’ perspectives of anticoagulation treatment satisfaction is also important, as this may impact adherence and therefore outcomes 10.…”

Addressing Disparities in Stroke Prevention for Atrial Fibrillation

“…A recently published survey supports the continuing need for clinician education on newer anticoagulants. 7 A practical guide comparing oral anticoagulants is now available from the European Heart Rhythm Association. 20 A unique aspect of this study's needs assessment was the evaluation of racial disparities in AF.…”

“…[4][5][6] Fear of bleeding, complicated monitoring, and an underappreciation of the clinical significance associated with AF are among the potential reasons why preventive therapy is underused. 4,7 Mortality rates related to stroke differ substantially both geographically and racially. People living in the southeastern United States have a higher-than-average stroke-related death rate compared with people living in other regions of the country.…”

“…4-6 Fear of bleeding, complicated monitoring, and an underappreciation of the clinical significance associated with AF are among the potential reasons why preventive therapy is underused. 4,7…”