Why the study?
How do physician specialties vary in their decisions to prescribe oral anticoagulants for patients with atrial fibrillation?
How do physician specialties vary in their decisions to prescribe oral anticoagulants for patients with atrial fibrillation?
There is substantial variation among physician specialties in the decision to anticoagulate patients with nonrheumatic atrial fibrillation, driven by differing estimations of embolic risk.
Answers are grounded in this paper and cite their sources.
Specialty variation in AF anticoagulation should not yet change practice; leaves open need for standardized risk assessment and outcome studies.
• We investigated variations in the oral anticoagulant treatment of atrial fibrillation by physicians in three specialties: family physicians (or general practitioners), general internists, and cardiologists. Results showed general agreement in the anticoagulation decision regarding patients with either mitral valve disease or a history of chronic alcohol abuse, but substantial disagreement in other categories of patients. Estimations of the risk of embolization and risk of hemorrhage differed widely among all physicians, cardiologists generally rating the embolization risks lower than the other physicians. A physician's treatment decision was strongly related to the relative risk of embolism vs hemorrhage derived for each case. A relationship between physician specialty and treatment decision was also demonstrated, with cardiologists least likely, and family practitioners most likely, to institute anticoagulation in nonrheumatic patients with atrial fibrillation. The reason for this variation appears to be differences in the estimated risk of systemic embolism. (Arch Intern Med. 1990;150:81-84)
No takes yet. Share an insight, caveat, or question.
Huan J. Chang (1990) studied this question.
Synapse has enriched 10 related papers. Consider them for comparative context: