Peterson, GM and Boom, K and Jackson, SL and Vial, JH, Doctors' beliefs on the use of antithrombotic therapy in atrial fibrillation: identifying barriers to stroke prevention, Internal Medicine Journal, 32, (1-2) pp. 15-23. ISSN 1444-0903 (2002) [Refereed Article]
The definitive published version is available online at: http://onlinelibrary.wiley.com/
Official URL: http://onlinelibrary.wiley.com/
Aims: To assess the attitudes of Australian doctors towards the use of antithrombotic drug therapy for stroke prevention in patients with non-valvular atrial fibrillation (AF), and investigate the barriers to prescribing warfarin.
Methods: A postal survey was undertaken among approximately 10% of all registered general practitioners (GPs), cardiologists and physicians in Australia. The anonymous questionnaire used case scenarios to assess doctorsí knowledge of current guidelines for the therapeutic management of AF and sought opinions on potential barriers to the use of anticoagulation.
Results: Completed questionnaires were received from 711 doctors (30% response rate). The GPs performed better than the cardiologists and other specialists in estimating the risk of stroke in case scenarios. However, the cardiologists were more likely to select the recommended treatment, with GPs being more hesitant to use anticoagulation and tending to underestimate its reported benefit for stroke prevention in non-valvular AF. The GPs were also more likely to overestimate the reported risk of major bleeds with warfarin. In contrast, over one-third of the cardiologists went as far as to give warfarin to a low-risk patient and they were more likely to overestimate the reported benefit of aspirin and warfarin in AF. Only half the doctors correctly classified a patient without a previous stroke (but with other risk factors) as being at high risk. Increased experience as a registered medical practitioner was generally related to a poorer performance on classifying patients according to the risk of stroke. The principal barriers to the use of anticoagulation were nominated as: (i) active gastrointestinal bleeding, (ii) previous intracranial haemorrhage, (iii) alcoholism, (iv) a history of daily falls, (v) liver disease, (vi) severe anaemia and (vii) concurrent use of non-steroidal anti-inflammatory drugs.
Conclusion: There is scope for improvement in doctorsí knowledge about the appropriate use of antithrombotic drug therapy in non-valvular AF and awareness of the results of recent clinical trials. Compilation and dissemination of clear guidelines and focused education on some of the other risk factors (apart from previous stroke or transient ischaemic attacks) in patients with non-valvular AF are important strategies for targeting barriers to the use of anticoagulation for stroke prevention.
|Item Type:||Refereed Article|
|Keywords:||anticoagulation, aspirin, atrial fibrillation, barriers;prescribing, stroke, warfarin|
|Research Division:||Medical and Health Sciences|
|Research Group:||Public Health and Health Services|
|Research Field:||Public Health and Health Services not elsewhere classified|
|Objective Group:||Other Health|
|Objective Field:||Health not elsewhere classified|
|Author:||Peterson, GM (Professor Gregory Peterson)|
|Author:||Jackson, SL (Dr Shane Jackson)|
|Author:||Vial, JH (Associate Professor Janet Vial)|
|Web of Science® Times Cited:||51|
|Deposited By:||Medicine (Discipline)|
|Downloads:||3 View Download Statistics|
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