Initiation of anticoagulation in atrial fibrillation by primary care physicians: Results of a telephone survey

Abstract Background As the large number of CHS centers in China face the majority of NVAF patients, primary care physicians (PCPs) play the primary role in the prevention of embolization. Therefore, an awareness of anticoagulant management in NVAF patients must be brought into focus among PCPs in China. This study will help primary care physicians (PCPs) increase their awareness of oral anticoagulant (OAC) therapy for non-valvular atrial fibrillation (NVAF) to prevent embolization.Method This was a cross-sectional observational study of 462 PCPs in community health service (CHS) centers across Shanghai. We used a self-administered questionnaire to collect data from September to December 2017. A stratified random cluster sampling was adopted in the 90 CHS centers with the family medicine residency program.Result Among 462 participants, 69.3% (320/462) of females with a medical bachelor’s degree and more than 10 years of work experience predominated in the 30 to 49 years of age group. The mean score for “knowledge,” “attitude” and “practices” of OAC therapy in NVAF patients among PCPs was 3.68±2.752, 53.62±7.148, and 37.63±10.336, respectively. The level of knowledge of OAC therapy in NVAF patients among PCPs was insufficient in over half (75.8%) of participants. The majority (89.8%) of PCPs had a positive attitude and 68.0% had modest performance in the anticoagulant management of NVAF patients.Conclusion The knowledge and behaviors of PCPs were insufficient in OAC therapy to prevent embolization in NVAF patients. The study also revealed the positive attitudes of participants, and their desire to learn the latest knowledge of OAC therapy.

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Therapeutic behavior of primary care physicians in patients with atrial fibrillation taking vitamin K antagonists not adequately controlled

European Journal of Internal Medicine ◽

10.1016/j.ejim.2016.01.016 ◽

2016 ◽

Vol 30 ◽

pp. e17-e18 ◽

Cited By ~ 8

Author(s):

Carlos Escobar ◽

Vivencio Barrios ◽

Luis Prieto

Keyword(s):

Atrial Fibrillation ◽

Primary Care ◽

Vitamin K ◽

Primary Care Physicians ◽

Vitamin K Antagonists ◽

Therapeutic Behavior

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A study of knowledge, attitudes, and practices of primary care physicians toward anticoagulant therapy in patients with non-valvular atrial fibrillation in Shanghai, China

BMC Family Practice ◽

10.1186/s12875-020-01236-4 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Shasha Ye ◽

Tianhao Wang ◽

Arthur Liu ◽

Ying Yu ◽

Zhigang Pan ◽

...

Keyword(s):

Atrial Fibrillation ◽

Primary Care ◽

Anticoagulant Therapy ◽

Primary Care Physicians ◽

Attitudes And Practices ◽

Knowledge Attitudes And Practices

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P3769Rapid referral to a one-stop AF clinic following possible AF detection by community pharmacists leads to early diagnosis and appropriate anticoagulant treatment

European Heart Journal ◽

10.1093/eurheartj/ehz745.0619 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Antoniou ◽

L Barnett ◽

J Craig ◽

H Patel ◽

T Lobban ◽

...

Keyword(s):

Atrial Fibrillation ◽

Primary Care ◽

Community Pharmacy ◽

Primary Care Physicians ◽

Healthcare Professionals ◽

Community Pharmacists ◽

Long Term Conditions ◽

Patient Consent ◽

One Stop ◽

Pulse Check

Abstract Background Atrial fibrillation is the most common cardiac arrhythmia globally, responsible for one third of ischaemic strokes, often resulting in death or incapacity. This condition, frequently asymptomatic is estimated to be up to 50% undiagnosed. Reducing this risk with appropriate detection and management strategies offers substantial economic and patient benefits. Community pharmacists have been shown to be an accessible healthcare professional capable of detecting atrial fibrillation. Concerns raised utilising community pharmacists is the additional workload for primary care physicians, and lack of a clear pathway to ensure patients are adequate followed with assurance of initiation of anticoagulation therapy. Purpose To assess the feasibility of screening by community pharmacists with onward referral to an innovative one-stop AF clinic to enable identification of new cases of AF and subsequent initiation of anticoagulation within 2 weeks. Methods 21 pharmacies were recruited and trained on pathophysiology of AF and demonstration of pulse taking using pulse check and Kardia mobile device. Any person walking into a community pharmacy aged ≥65 years was offered a free pulse check. For any irregularity detected, individualised counselling was offered with a referral made to a one-stop AF clinic for confirmation and initiation of anticoagulation. Written patient consent was obtained. Results 672 people were recruited with an average age of 69±3.5 years and 58% female (n=389). There was a history of hypertension in 618 (92%) and diabetes in 242 (36%), the most common co-morbidities. 45 people were referred following an irregular pulse or abnormal ECG rhythm strip, of whom 11 (1.6% of total population) had a confirmed AF diagnosis within 30 day follow up. An additional 8 cases with known AF not receiving anticoagulation termed (actionable AF) were also referred. All 19 cases of new or untreated AF were prescribed anticoagulation by the one stop clinic in accordance with guideline recommendations Conclusions ESC guidance recommends opportunistic screening for AF by pulse taking or ECG rhythm strip in patients ≥65 years of age. The 1.6% incidence of new AF was in accordance with meta-analyses identifying 1.4% of those aged ≥65 on a single time point check for presence of AF. Our model utilises the un-tapped skills of community pharmacy to deliver pulse checks of ECG rhythm recordings in an accessible primary care location with a clear referral pathway that is effective in early review and ensuring suitable patients receive anticoagulation. The innovative pathway could provide remote triage at scale and help address the missing people with undiagnosed and actionable AF by opening new channels for identification by healthcare professionals managing long term conditions who like pharmacists have not been considered suitable healthcare professionals due to lack of an established pathway for confirming the potential diagnosis of AF. Acknowledgement/Funding NHS England Test Bed Programme

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Management of Patients With Atrial Fibrillation by Primary-Care Physicians in Germany: 1-Year Results of the ATRIUM Registry

Clinical Cardiology ◽

10.1002/clc.22272 ◽

2014 ◽

Vol 37 (5) ◽

pp. 277-284 ◽

Cited By ~ 18

Author(s):

Paulus Kirchhof ◽

Janine Schmalowsky ◽

David Pittrow ◽

Ludger Rosin ◽

Wilhelm Kirch ◽

...

Keyword(s):

Atrial Fibrillation ◽

Primary Care ◽

Primary Care Physicians

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A study of knowledge, attitudes, and practices of primary care physicians toward anticoagulant therapy in patients with non-valvular atrial fibrillation in Shanghai, China

10.21203/rs.2.20341/v3 ◽

2020 ◽

Author(s):

Shasha Ye ◽

Tianhao Wang ◽

Arthur Liu ◽

Ying Yu ◽

Zhigang Pan ◽

...

Keyword(s):

Atrial Fibrillation ◽

Primary Care ◽

Anticoagulant Therapy ◽

Work Experience ◽

Primary Care Physicians ◽

Educational Interventions ◽

Cluster Sampling ◽

Primary Role ◽

Attitudes And Practices ◽

Knowledge Attitudes And Practices

Abstract Background:As a large number of Community Health Service (CHS) centers in China face the majority of patients with non-valvular atrial fibrillation (NVAF), primary care physicians (PCPs) play a primary role in the prevention of embolization. Therefore, an awareness of anticoagulant management in patients with NVAF must be brought into focus among PCPs in China. This study investigated PCPs’ knowledge, attitudes, and practices toward anticoagulant therapy in patients with NVAF, to help them understand their shortcomings regarding oral anticoagulant (OAC) therapy in preventing embolization.Method:This was a cross-sectional observational study of 462 PCPs in CHS centers across Shanghai. We used a self-administered questionnaire to collect data from September to December 2017. A stratified random cluster sampling was adopted in the 90 CHS centers with the family medicine residency program.Result:Among 462 participants, 69.3% (320/462) of females received a medical bachelor’s degree and over 50% of participants had more than 10 years of work experience. Each section for knowledge, attitude, and practice were categorized as poor (≤39.0%), fair (40.0%–69.0%), and good (≥70.0%). The level of knowledge of OAC therapy for patients with NVAF among PCPs was insufficient in over half (75.8%) of the participants. The majority (89.8%) of PCPs had a positive attitude and 68.0% had modest performance in the anticoagulant management of patients with NVAF.Conclusions: The knowledge and behaviors of PCPs were insufficient for OAC therapy to prevent embolization in patients with NVAF. The study also revealed that there is good potential for PCPs’ educational interventions to positively impact the care of patients with NVAF.

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Effects of Time from Onset or Diagnosis of Atrial Fibrillation to Catheter Ablation on Outcomes : The Role of Primary Care Physicians

Japanese Journal of Electrocardiology ◽

10.5105/jse.40.158 ◽

2020 ◽

Vol 40 (3) ◽

pp. 158-166

Author(s):

Yoshitaro Matsumoto ◽

Atsushi Kobori ◽

Koichiro Kumagai ◽

Hideko Toyama ◽

Hisako Yoshida ◽

...

Keyword(s):

Atrial Fibrillation ◽

Primary Care ◽

Catheter Ablation ◽

Primary Care Physicians

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Factors Influencing Primary Care Physicians’ Prescribing Behavior of Anticoagulant Therapy for the Management of Patients With Non-valvular Atrial Fibrillation in the Community: a Qualitative Research Study

10.21203/rs.3.rs-145073/v1 ◽

2021 ◽

Author(s):

Shera Chaterji ◽

Lay Geok Lian ◽

Ting Yee Lee ◽

Liwei Chua ◽

Sabrina Wee ◽

...

Keyword(s):

Atrial Fibrillation ◽

Primary Care ◽

Decision Making ◽

Qualitative Research ◽

Healthcare System ◽

Anticoagulant Therapy ◽

Primary Care Physicians ◽

Medication Cost ◽

Care Model ◽

Factors Influencing

Abstract Background: Oral anticoagulant therapy use in patients with atrial fibrillation (AF) remains suboptimal despite the availability of both warfarin and non-vitamin K antagonist oral anticoagulants (NOACs). Primary care physicians’ (PCP) decision-making to initiate and select appropriate anticoagulant medication is pivotal in reducing complications among patients with AF.Aim: This study explored the factors influencing PCPs’ decision-making in anticoagulant initiation and adjustment for patients with non-valvular AF. Design of study: Qualitative research based on the theoretical framework of the Generalist Wheel of Knowledge, Understanding and Inquiry. Method: In-depth interviews or focus group discussions were conducted with 27 PCPs in general practice in urban Singapore. The audio-recordings were transcribed, audited and coded to identify themes, which are framed according to the “clinician”, “patient”, “medical condition and treatment” and “healthcare system and policy” domains.Results: Personal training and experience with anticoagulant therapy; understanding patient risk-stratification; AF detection during clinical practice; medication cost; clinical support services for anticoagulation monitoring and constraints in existing care model influenced PCPs in their anticoagulant prescription. PCPs preferred to seek guidance from cardiologists in managing patients with newly diagnosed AF and attempted to engage their patients in decision-making regarding anticoagulant therapy. They perceived sub-specialized primary care clinics focusing on AF co-management with cardiologists as an ideal setting for initiation and maintenance of anticoagulant therapy.Conclusion: PCPs’ decisions on anticoagulant therapy is influenced by personal attributes, patients, clinical presentations, anticoagulant properties and healthcare system. Their proposed care model to address the barriers awaits feasibility and acceptance assessment in future research.

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