Introduction:
Stroke prevention is a cornerstone in the management of patients with AF at higher risk for ischemic events. This study assessed physician barriers to management of AF patients, including gaps in clinical knowledge and application of tools and guidelines for reducing stroke risk. Awareness, perception, and confidence in adopting newer anticoagulants were investigated, particularly related to balancing risk with treatment goals, and knowledge sources sought by physicians.
Methods:
The data for this study, conducted from March 2011 to May 2011, were collected through the use of a nationally-distributed case vignette survey to cardiologists and primary care physicians (PCPs), as well as patient chart audits nested within the physician sample. Each component of this study was reviewed and approved by the Western Institutional Review Board (WIRB).
Results:
Surveys from 142 cardiologists and 250 PCPs, and 632 patient chart audits, were analyzed. Nearly half of cardiologists and more than 75% of PCPs surveyed identified uncertainty regarding stroke risk assessment and lack of awareness of tools to guide risk assessment as barriers to determining appropriate antithrombotic therapy. Case vignette assessment found that 44% of PCPs familiar with the CHADS2 risk assessment tool were unable to appropriately assign a risk score, and they were less likely than cardiologists (53% vs 85%) to use this tool in clinical practice. Consistent with their greater familiarity, 65% of cardiologists are very confident in using emerging anticoagulants, while only 40% of PCPs have comparable confidence. The most frequently sought and valued resources for information about emerging anticoagulants were clinical practice guidelines, journal articles, CME activities, and communication with physician peers.
Conclusion:
Knowledge gaps and clinical barriers exist among physicians for stroke risk assessment, anticoagulation management, and use of emerging therapies in patients with AF. Physicians seek independent evidence-based information when deciding how to incorporate new anticoagulants into practice. The data suggest that physicians value education on safety and efficacy of therapies as well as practical guidance on applying clinical data to practice.