Barriers to the Use of Anticoagulation for Nonvalvular Atrial Fibrillation

Gattellari, Melina; Worthington, John; Zwar, Nicholas; Middleton, Sandy

doi:10.1161/strokeaha.107.495036

Cited by 109 publications

(78 citation statements)

References 12 publications

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“…4,5 For Nonadherence to guideline-directed OAC use may also be influenced by many variables, including the healthcare system, physician factor, and patient-level considerations. 35 To improve OAC treatment among patients with AF, numerous methods have included establishment of specialized anticoagulation clinics, antithrombotic education programs, anticoagulation intensity monitoring, point-of-care patient self-testing, and computerized algorithms for warfarin dose adjustment. 36 In addition, promoting a rational appraisal of the risks and benefits of anticoagulation is essential to reduce decisional conflicts for physicians.…”

Section: Discussionmentioning

confidence: 99%

Current Status and Time Trends of Oral Anticoagulation Use Among Chinese Patients With Nonvalvular Atrial Fibrillation

Chang¹,

Dong²,

Ma³

et al. 2016

Stroke

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A trial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide. In 2008, the estimated agestandardized AF prevalence in China was 0.65%, suggesting that at least 4 million adults had AF, 1 and it was predicted that 5.2 million men and 3.1 million women aged >60 years will be affected by AF in China by 2050. 2AF increases the risk of stroke, and AF-related stroke is more fatal and disabling, compared with non-AF stroke.3 Oral anticoagulation (OAC) is recommended to reduce the risk of thromboembolic events in patients with AF with either a moderate or high risk of stroke. 4,5 Various registry studies report that nearly half to four fifths of high-risk AF patients were taking OAC therapy in developed countries 6-10 ; however, in Chinese patients with AF, OAC remains underused. 11During the past decade, the Chinese medical societies have made great efforts to improve stroke prevention among Background and Purpose-Reported rates of oral anticoagulation (OAC) use have been low among Chinese patients with atrial fibrillation (AF). With improved awareness, changing guidelines, this situation may be changing over time. We aimed to explore the current status and time trends of OAC use in Beijing. Methods-We used the data set from the Chinese Atrial Fibrillation Registry (CAFR), a prospective, multicenter, hospitalbased registry study involving 20 tertiary and 12 nontertiary hospitals in Beijing. A total of 11 496 patients with AF were enrolled from 2011 to 2014. Results-Seven thousand nine hundred seventy-seven eligible patients were included in this ancillary study.

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Section: Discussionmentioning

confidence: 99%

Current Status and Time Trends of Oral Anticoagulation Use Among Chinese Patients With Nonvalvular Atrial Fibrillation

Chang¹,

Dong²,

Ma³

et al. 2016

Stroke

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show abstract

“…9 Another local study reported more than 30% of AF patients did not receive appropriate antithrombotic therapy; 34% of AF patients were treated with aspirin alone, and 22% of them were not receiving any antithrombotic therapy. 10 The aims of this study were to assess the knowledge of Hong Kong physicians in stroke prevention management for AF patients and the understanding of AF and warfarin therapy in Hong Kong Chinese AF patients, and to compare the knowledge levels of both physicians and patients with those in Western countries.…”

Section: Introductionmentioning

confidence: 99%

Barriers to Warfarin Use for Stroke Prevention in Patients With Atrial Fibrillation in Hong Kong

Lee

Tam

Yan

et al. 2012

Clinical Cardiology

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Background:Oral anticoagulation medications such as warfarin reduce the risk of stroke in atrial fibrillation (AF) but have been underutilized. This study aimed to investigate physicians' perceptions of stroke prevention management and patients' knowledge of AF and warfarin therapy in Hong Kong (HK).Hypothesis:Both physician and patient's knowledge on warfarin use were the barriers for stroke prevention in patients with atrial fibrillation in Hong Kong.Methods:This prospective survey‐based study was conducted between February 2011 and April 2011 to assess physicians' perceptions of stroke prevention management, patients' knowledge of AF, and patients' knowledge of warfarin therapy. The results were scored and compared with those in foreign countries.Results:Sixty‐two physicians and 114 warfarin users were recruited in the study. The average score of HK physicians in the knowledge of stroke prevention therapy in AF patients was lower than that of Australian (AUS) family physicians (HK 2.48 vs AUS 4.02 out of 7). The mean scores of AF patients in Hong Kong regarding the knowledge of AF were lower than that of United Kingdom (UK) (HK 1.16 vs UK 2.24 out of 4) (P < 0.001) and that of Finland (FIN) (HK 2.77 vs FIN 5.94 out of 8) (P < 0.001), respectively. The mean score of AF patients in Hong Kong regarding the knowledge of warfarin therapy was lower than that of AF patients in the United States (US) (HK 2.39 vs US 3.92).Conclusions:The barriers of warfarin use for AF patients in Hong Kong were related to both physicians and patients. Many Hong Kong physicians did not comply with international recommendations of stroke prevention in AF patients, and AF patients had a low knowledge level about the disease and warfarin therapy.Presented at the International Congress of Cardiology, Hong Kong, Peoples Republic of China, February 24‐26, 2012.This study was supported by the School of Pharmacy, the Chinese University of Hong Kong.The authors have no other funding, financial relationships, or conflicts of interest to disclose.

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“…Although shared decision-making, patients' preferences, and noncompliance with medical regimens are certainly factors in OAC underuse, clinicians' judgment appears to play the chief role. [21][22][23][24] The reasons typically cited for not prescribing OACs are bleeding risk, older age, the risk of falls, and patient noncompliance. [23][24][25] In fact, two of the strongest risk factors for stroke in AF-prior stroke and increasing age-are actually indicators of withholding appropriate anticoagulant therapy.…”

Section: Underuse Of Oral Anticoagulants For Nonvalvular Atrial Fibrimentioning

confidence: 99%

Underuse of Oral Anticoagulants for Nonvalvular Atrial Fibrillation: Past, Present, and Future

Wehbe¹,

Yadlapati²

2016

Texas Heart Institute Journal

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Barriers to the Use of Anticoagulation for Nonvalvular Atrial Fibrillation

Cited by 109 publications

References 12 publications

Current Status and Time Trends of Oral Anticoagulation Use Among Chinese Patients With Nonvalvular Atrial Fibrillation

Current Status and Time Trends of Oral Anticoagulation Use Among Chinese Patients With Nonvalvular Atrial Fibrillation

Barriers to Warfarin Use for Stroke Prevention in Patients With Atrial Fibrillation in Hong Kong

Underuse of Oral Anticoagulants for Nonvalvular Atrial Fibrillation: Past, Present, and Future

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