The Educational Needs of Clinicians Regarding Anticoagulation Therapy for Prevention of Thromboembolism and Stroke in Patients With Atrial Fibrillation

Abstract

The objective is to identify practice patterns and attitudes of and barriers faced by US physicians assessing thromboembolism/stroke risk and managing anticoagulation in atrial fibrillation (AF) to determine educational needs. Case-based surveys were used to assess practice patterns, guideline use, barriers, and attitudes; 51 cardiologists and 50 primary care physicians (PCPs) were surveyed. Most cardiologists use validated risk scoring systems to assess thromboembolism/stroke risk, and more than half of PCPs use clinical experience. Assessment of bleeding risk varied; more than half of respondents rely on clinical judgment or patient bleeding history. The most commonly used prophylactic agents are warfarin/another vitamin K antagonist (PCPs) or antiplatelet agents (cardiologists). Newer anticoagulants are used less frequently. Bleeding risk, need for frequent monitoring (vitamin K antagonists), and medication costs were the most significant barriers. Cardiologists and PCPs could benefit from education on validated scoring systems to assess risk of thromboembolism/stroke and bleeding in AF, on newly released AF guidelines, and on newer anticoagulants.