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Tasmanian hospital clinicians' attitudes regarding stroke prevention in atrial


Chalmers, L and Scott, BE and Curtain, CM and Bereznicki, LRE, Tasmanian hospital clinicians' attitudes regarding stroke prevention in atrial, Medicines Management 2015: The 41st SHPA National Conference, 3-6 December, 2015, Melbourne, Australia, pp. 82. (2015) [Conference Extract]

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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.

Item Details

Item Type:Conference Extract
Keywords:atrial fibrillation, stroke prevention, prescribing
Research Division:Biomedical and Clinical Sciences
Research Group:Pharmacology and pharmaceutical sciences
Research Field:Clinical pharmacology and therapeutics
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Chalmers, L (Dr Leanne Chalmers)
UTAS Author:Scott, BE (Ms Bryony Scott)
UTAS Author:Curtain, CM (Mr Colin Curtain)
UTAS Author:Bereznicki, LRE (Professor Luke Bereznicki)
ID Code:105133
Year Published:2015
Deposited By:Pharmacy
Deposited On:2015-12-09
Last Modified:2015-12-11

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