Exploring clinician perspectives on patients with atrial fibrillation who are not prescribed anticoagulation therapy
Year: 2022
Type: article
Abstract: Background Evidence-based guidelines strongly recommend oral anticoagulants to prevent stroke in patients with non-valvular atrial fibrillation (AF). However, many patients are not prescribed guideline recommended anticoagulant therapy. Objectives To explore themes underlying anticoagulant prescribing or discontinuation in patients with AF and compare and contrast prescribing preferences between cardiologists and general practitioners. Methods Providers at the University of Utah Health system were recruited to participate in semi-structured interviews. An interview guide directed the 15-minute interviews with focus on anticoagulant prescribing practices for patients with AF. Interviews were transcribed verbatim. Two reviewers independently read transcripts and labeled passages of text corresponding with key concepts and themes. Results Of the eleven practitioners interviewed, seven practiced in cardiology, two in internal medicine and two in family medicine. The most prominent reasons cited for not prescribing anticoagulation for stroke prevention in AF patients were concerns about intracranial bleeding, followed by gastrointestinal bleeding. Other common reasons were increased age, thrombocytopenia, chemotherapy, previous or concerns of noncompliance, and comorbidities. Providers believed patient refusal of anticoagulants was related to fear of bleeding, medication burden, or warfarin’s negative reputation. All prescribers reported similar prescribing strategies, including using risk stratification, shared decision making, and utilizing specialized anticoagulation clinics and pharmacists as resources. Conclusion Fear of bleeding was a common theme underlying anticoagulant underutilization in patients with AF. Identifying major reasons directly from providers can be utilized to develop patient education addressing common fears and misconceptions, promote shared decision making, and provide provider education and resources to achieve appropriate anticoagulant prescribing.
Source: PEC Innovation
Authors: Catherine Yao, Aubrey E. Jones, Stacey Slager, Angela Fagerlin, Daniel M. Witt
Institutions: University of Utah, Center for Innovation
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,500
OpenAlex ID: W4283760184