A national survey of the management of atrial fibrillation with antithrombotic drugs in Italian primary care

2010 ◽  
Vol 103 (05) ◽  
pp. 968-975 ◽  
Author(s):  
Alessandro Filippi ◽  
Marianna Alacqua ◽  
Warren Cowell ◽  
Annabelle Shakespeare ◽  
Lorenzo Mantovani ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Risk Stratification ◽  
Primary Care Physicians ◽  
Stroke Risk ◽  
Risk Profile ◽  
Antithrombotic Drugs ◽  
Factors Associated ◽  
Primary Care Data ◽  
Males And Females

SummaryThe aims of this study were to investigate trends in the incidence of diagnosed atrial fibrillation (AF), and to identify factors associated with the prescription of antithrombotics (ATs) and to identify the persistence of patients with oral anticoagulant (OAC) treatment in primary care. Data were obtained from 400 Italian primary care physicians providing information to the Health Search/Thales Database from 2001 to 2004. The age-standardised incidence of AF was: 3.9–3.0 cases, and 3.6–3.0 cases per 1,000 person-years in males and females, respectively. During the study period, 2,016 (37.2%) patients had no prescription, 1,663 (30.7%) were prescribed an antiplatelet (AP) agent, 1,440 (26.6%) were prescribed an OAC and 301 (5.5%) had both prescriptions. The date of diagnosis (p = 0.0001) affected the likelihood of receiving an OAC. AP, but not OAC, use significantly increased with a worsening stroke risk profile using the CHADS2 risk score. Older age increased the probability (p < 0.0001) of receiving an AP, but not an OAC. Approximately 42% and 24% of patients persisted with OAC treatment at one and two years, respectively, the remainder interrupted or discontinued their treatment. Underuse and discontinuation of OAC treatment is common in incident AF patients. Risk stratification only partially influences AT management.

scholarly journals Screening and management of atrial fibrillation in primary care

BMJ ◽  
2021 ◽  
pp. n379
Author(s):  
Shiva P Ponamgi ◽  
Konstantinos C Siontis ◽  
David R Rushlow ◽  
Jonathan Graff-Radford ◽  
Victor Montori ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Stroke Risk ◽  
Diagnostic Testing ◽  
Therapeutic Agents ◽  
Rhythm Control ◽  
Medical Illness ◽  
Hospital Services ◽  
Common Chronic Disease

AbstractAtrial fibrillation is a common chronic disease seen in primary care offices, emergency departments, inpatient hospital services, and many subspecialty practices. Atrial fibrillation care is complicated and multifaceted, and, at various points, clinicians may see it as a consequence and cause of multi-morbidity, as a silent driver of stroke risk, as a bellwether of an acute medical illness, or as a primary rhythm disturbance that requires targeted treatment. Primary care physicians in particular must navigate these priorities, perspectives, and resources to meet the needs of individual patients. This includes judicious use of diagnostic testing, thoughtful use of novel therapeutic agents and procedures, and providing access to subspecialty expertise. This review explores the epidemiology, screening, and risk assessment of atrial fibrillation, as well as management of its symptoms (rate and various rhythm control options) and stroke risk (anticoagulation and other treatments), and offers a model for the integration of the components of atrial fibrillation care.

scholarly journals CHARGE-AF in a national routine primary care electronic health records database in the Netherlands: validation for 5-year risk of atrial fibrillation and implications for patient selection in atrial fibrillation screening

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001459
Author(s):  
Jelle C L Himmelreich ◽  
Wim A M Lucassen ◽  
Ralf E Harskamp ◽  
Claire Aussems ◽  
Henk C P M van Weert ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
High Risk ◽  
The Netherlands ◽  
Patient Selection ◽  
Low Cost ◽  
Calibration Plot ◽  
Primary Care Data ◽  
C Statistic ◽  
Kaplan Meier

AimsTo validate a multivariable risk prediction model (Cohorts for Heart and Aging Research in Genomic Epidemiology model for atrial fibrillation (CHARGE-AF)) for 5-year risk of atrial fibrillation (AF) in routinely collected primary care data and to assess CHARGE-AF’s potential for automated, low-cost selection of patients at high risk for AF based on routine primary care data.MethodsWe included patients aged ≥40 years, free of AF and with complete CHARGE-AF variables at baseline, 1 January 2014, in a representative, nationwide routine primary care database in the Netherlands (Nivel-PCD). We validated CHARGE-AF for 5-year observed AF incidence using the C-statistic for discrimination, and calibration plot and stratified Kaplan-Meier plot for calibration. We compared CHARGE-AF with other predictors and assessed implications of using different CHARGE-AF cut-offs to select high-risk patients.ResultsAmong 111 475 patients free of AF and with complete CHARGE-AF variables at baseline (17.2% of all patients aged ≥40 years and free of AF), mean age was 65.5 years, and 53% were female. Complete CHARGE-AF cases were older and had higher AF incidence and cardiovascular comorbidity rate than incomplete cases. There were 5264 (4.7%) new AF cases during 5-year follow-up among complete cases. CHARGE-AF’s C-statistic for new AF was 0.74 (95% CI 0.73 to 0.74). The calibration plot showed slight risk underestimation in low-risk deciles and overestimation of absolute AF risk in those with highest predicted risk. The Kaplan-Meier plot with categories <2.5%, 2.5%–5% and >5% predicted 5-year risk was highly accurate. CHARGE-AF outperformed CHA2DS2-VASc (Cardiac failure or dysfunction, Hypertension, Age >=75 [Doubled], Diabetes, Stroke [Doubled]-Vascular disease, Age 65-74, and Sex category [Female]) and age alone as predictors for AF. Dichotomisation at cut-offs of 2.5%, 5% and 10% baseline CHARGE-AF risk all showed merits for patient selection in AF screening efforts.ConclusionIn patients with complete baseline CHARGE-AF data through routine Dutch primary care, CHARGE-AF accurately assessed AF risk among older primary care patients, outperformed both CHA2DS2-VASc and age alone as predictors for AF and showed potential for automated, low-cost patient selection in AF screening.

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

2021 ◽  
Author(s):  
Stephanie Carlin ◽  
Alison Bond ◽  
Peter Gross ◽  
Alan Bell ◽  
James Douketis ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Telephone Survey

scholarly journals Diagnosis and Management of Atrial Fibrillation by Primary Care Physicians in Italy

2012 ◽  
Vol 32 (11) ◽  
pp. 771-777 ◽  
Author(s):  
Gaetano Piccinocchi ◽  
Matteo Laringe ◽  
Bruno Guillaro ◽  
Giovanni Arpino ◽  
Roberto Piccinocchi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Diagnosis And Management

scholarly journals Factors Associated With Primary Care Physicians’ Recognition of Cognitive Impairment in Their Older Patients

2014 ◽  
Vol 28 (4) ◽  
pp. 320-325 ◽  
Author(s):  
Mary C. Tierney ◽  
Gary Naglie ◽  
Ross Upshur ◽  
Liisa Jaakkimainen ◽  
Rahim Moineddin ◽  
...  
Keyword(s):  
Primary Care ◽  
Cognitive Impairment ◽  
Primary Care Physicians ◽  
Older Patients ◽  
Factors Associated

scholarly journals The study on knowledge-attitude-practice of primary care physician toward anticoagulants therapy in Non-valvular atrial fibrillation patients in Shanghai of China

2020 ◽  
Author(s):  
Shasha Ye ◽  
Tianhao Wang ◽  
Arthur Liu ◽  
Ying Yu ◽  
Zhigang Pan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Work Experience ◽  
Primary Care Physicians ◽  
Care Physician ◽  
Bachelor's Degree ◽  
Cluster Sampling ◽  
Primary Role ◽  
Cross Sectional ◽  
Positive Attitudes

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.

scholarly journals Validation of a Modified CHA 2 DS 2 -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation

Stroke ◽  
2016 ◽  
Vol 47 (10) ◽  
pp. 2462-2469 ◽  
Author(s):  
Tze-Fan Chao ◽  
Gregory Y.H. Lip ◽  
Chia-Jen Liu ◽  
Ta-Chuan Tuan ◽  
Su-Jung Chen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Stratification ◽  
Stroke Risk ◽  
Asian Patients

Abstract 66: Current Attitudes and Practice Patterns of Using New and Emerging Therapies to Manage Patients with Atrial Fibrillation (AF): a National Assessment of Cardiologists and Primary Care Physicians

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Gregory D Salinas ◽  
Caroline O Robinson ◽  
Nancy Roepke ◽  
B. S Burton ◽  
Debi Susalka ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Primary Care ◽  
Clinical Practice ◽  
Primary Care Physicians ◽  
Stroke Risk ◽  
Case Vignette ◽  
Independent Evidence ◽  
Patient Chart ◽  
Emerging Therapies ◽  
Chart Audits

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.

Abstract 211: Association of Patient Characteristics With the Initiation of Dabigatran Versus Warfarin Among Anticoagulant Naive Patients With Non-valvular Atrial Fibrillation

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
David R Walker ◽  
Jasmina Ivanova ◽  
Keith A Betts ◽  
Sapna Rao ◽  
Eric Q Wu
Keyword(s):  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Regression Model ◽  
Primary Care Physicians ◽  
Online Survey ◽  
Logistic Regression Model ◽  
Stroke Risk ◽  
Dabigatran Etexilate ◽  
Patient Characteristics ◽  
Categorical Variables

Background and Objective: Dabigatran etexilate (DE) and warfarin, both oral anticoagulants used for stroke risk reduction in patients with non-valvular atrial fibrillation (NVAF), have been or are being compared in several comparative effectiveness studies. Understanding patient characteristics of those prescribed DE vs. warfarin are important for interpreting such studies. The objective of this study is to identify the characteristics that differentiate NVAF patients prescribed DE versus warfarin as first-line anticoagulation. Methods: An online survey was administered in October 2012 to an established panel of cardiologists and primary care physicians (PCPs) in the US. Physicians were asked to identify medical charts of their patients diagnosed with NVAF and who had at least one prescription for DE or warfarin between 1/1/2011 and 6/30/2012. Patients were further required to be anticoagulant naïve prior to the first prescription of DE or warfarin. A computer generated random dice was applied to direct the random selection of the patients. Patient characteristics, comorbidities and clinical risk measures were compared between DE and warfarin patients using Chi-square tests for categorical variables and t-tests for continuous variables. A logistic regression model was utilized to evaluate patient characteristics associated with DE vs. warfarin use among anticoagulant naïve NVAF patients. Results: A total of 288 physicians (144 cardiologists and 144 PCPs) completed the survey. 262 medical records for DE patients and 247 for warfarin patients were randomly selected. The mean age of the DE and warfarin patients, respectively were 61.6 and 65.8 years (p < 0.01). The proportion of females was 20.6% and 41.7% in the DE and warfarin patients respectively (p<0.01). 86.3% of DE patients vs. 68.4% of warfarin patients were Caucasian (p<0.01). Other differences between DE and warfarin patients respectively included: previous myocardial infarction (3.8%, 9.3%; p<0.05), previous transient ischemic attack (8.4%, 16.2%; p <0.01), and CHA 2 DS 2 -VASc stroke risk score (2.21, 2.98; p<0.01). The logistic regression model found age (OR = 0.96; p=0.001), female gender (OR=0.46; p = 0.002), Hispanic/Latino (OR = 0.33; p=.007), Black (OR= 0.37; p = 0.006), and > 6 months and < 1 year for time from first NVAF diagnosis to first prescription date (OR = 0.38; p = 0.02) were associated with initiation of DE vs. warfarin. However, CHA 2 DS 2 -VASc was not found to be a significant predictor of anticoagulant prescription. Conclusions: Patients who are younger, male, Caucasian, and recently diagnosed with NVAF were significantly more likely to be initiated by their physician on DE vs. warfarin. These findings should be considered when doing comparative analyses of outcomes between patients on DE vs. warfarin.

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