Tasmanian hospital clinicians' attitudes regarding stroke prevention in atrial

Aim: Little is known about clinicians’ perspectives on stroke prophylaxis in atrial fibrillation (AF) since the introduction of the non-vitamin K antagonist oral anticoagulants (NOACs). This study aimed to investigate Tasmanian hospital clinicians’ current attitudes towards stroke prophylaxis in AF, their perceptions of the safety and effectiveness of different oral antithrombotics and their preferred agents.

Method: An online vignette-based survey was distributed via email to all clinicians affiliated with the three major Tasmanian public hospitals. Clinicians were requested to indicate their preferred antithrombotic therapy 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 95 respondents, 24 (25.3%) reported using contemporary evidence-based guidelines for stroke prophylaxis in AF; 85 (89.5%) and 55 (57.9%) used stroke and bleeding risk stratification tools, respectively. Thirty-one percent (18/58) agreed with the expert panel’s prescribing choices for four or more vignettes; this was unrelated to experience, clinical specialty, and use of scoring tools and guidelines (p all >0.05). Almost 70% of clinicians demonstrated a preference for NOACs, with rivaroxaban the preferred agent (48.9%). Clinicians felt knowledgeable about NOACs (77.3%), considering them as effective as warfarin (77.3%); however, safety concerns, especially the lack of antidotes (77.3% concerned), influenced confidence in NOAC prescribing (40.9% agreement). Fifty percent found it difficult to decide whether benefits of anticoagulant therapy outweighed the risks.

Conclusion: This study demonstrated suboptimal guideline utilisation and prescribing choices in fictional vignettes among a cohort of hospital-based clinicians. As hospital-initiated therapies are often continued long-term, it is essential that this population is educated and confident in prescribing stroke prophylaxis in AF. We conclude there remains a need for prescriber education and support services to promote optimal prescribing in this increasingly common condition.