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Clinicians’ attitudes and perceptions regarding stroke prevention in atrial fibrillation

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Scott, BE and Curtain, CM and Chalmers, L and Bereznicki, LRE, Clinicians' attitudes and perceptions regarding stroke prevention in atrial fibrillation, 2015 Joint APSA-ASCEPT Annual Conference, 29 November - 2 December, 2015, Hobart, Tasmania (2015) [Conference Extract]


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Abstract

Introduction: While appropriate oral anticoagulation in atrial fibrillation (AF) can significantly reduce the risk of stroke and is supported by evidenced-based guidelines, evidence suggests that it remains underused, or is used inappropriately. There is currently little data regarding clinicians’ perspectives on stroke prophylaxis in AF since the introduction of the non-vitamin K antagonist oral anticoagulants (NOACs).

Aims: To evaluate Australian clinicians’ attitudes in their prescribing of anticoagulants for stroke prevention in AF, including their perceptions of the safety and effectiveness of the NOACs and preferred agents.

Methods: A vignette-based survey was distributed to a random sample of Australian cardiologists and general practitioners (GPs) (n=500 each), and an online version of the survey was distributed via email to all clinicians affiliated with the three major Tasmanian public hospitals. Clinicians were asked to indicate their preferred anticoagulant treatment for seven fictional patients with AF. Prescribing choices were compared against expert consensus. Additional multiple-choice and Likert-item questions addressed their use of guidelines and risk stratification tools, attitudes and perceptions.

Results: Of 174 respondents (39 GPs, 40 cardiologists and 95 other hospital-based clinicians), 88% reported routinely using an AF stroke risk stratification tool but only 44.5% routinely used a bleeding risk score. Fifty-three per cent of cardiologists, 49% of GPs and 32% of other hospital-based clinicians agreed with the expert panel’s prescribing choices for four or more vignettes; this was unrelated to use of scoring tools and guidelines (p>0.05). Cardiologists were significantly (p = 0.005) more likely to favour a NOAC, with apixaban being the preferred agent. Choice of anticoagulant was also influenced by clinicians’ knowledge and confidence.

Discussion: This study demonstrated that prescribing patterns varied between cardiologists, GPs and other hospitalbased clinicians. Concerns over the safety of NOACs were identified as potential barriers to their utilisation by GPs and other hospital-based clinicians. Results from the vignettes demonstrated sub-optimal prescribing choices amongst all clinicians. Further education is required to ensure all clinicians are educated and confident prescribing stroke prophylaxis in AF.

Item Details

Item Type:Conference Extract
Keywords:atrial fibrillation, stroke prevention, prescribing
Research Division:Medical and Health Sciences
Research Group:Pharmacology and Pharmaceutical Sciences
Research Field:Clinical Pharmacology and Therapeutics
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Scott, BE (Ms Bryony Scott)
Author:Curtain, CM (Mr Colin Curtain)
Author:Chalmers, L (Dr Leanne Chalmers)
Author:Bereznicki, LRE (Professor Luke Bereznicki)
ID Code:105135
Year Published:2015
Deposited By:Pharmacy
Deposited On:2015-12-09
Last Modified:2015-12-11
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