Key result
Survey shows 67% of Australian GPs rely on formal stroke risk tools when initiating anticoagulants.
Why the study?
Clinical guidelines recommend oral anticoagulants for AF with moderate-to-high stroke risk, but deviations occur in primary care.
Cross-Sectional
Australian general practitioners report relying on formal stroke and bleeding risk assessment tools primarily at the time of oral anticoagulant initiation, highlighting a need for more focus on regular risk reassessment.
May signal gaps in ongoing AF risk reassessment after OAC initiation; leaves open impact of routine monitoring on outcomes.
RATIONALE AND OBJECTIVES: Clinical guidelines produced by cardiology societies (henceforth referred to simply as 'clinical guidelines') recommend thromboprophylaxis with oral anticoagulants (OACs) in patients with atrial fibrillation (AF) who have moderate-to-high stroke risk. However, deviations from these recommendations are observed, especially in the primary healthcare setting. The primary aims of this study were to evaluate the self-reported use of AF clinical guidelines and risk stratification tools among Australian general practitioners (GPs), and their perceptions regarding the available resources. METHOD: We conducted an online survey of Australian GPs. Descriptive statistics were used to summarise the findings. RESULTS: ' (37.2%) and Royal Australian College of General Practitioners websites (16.8%). Of those who reported reasons against accessing information from clinical guidelines (n = 97), the most frequent issues were: too many AF guidelines to choose from (34.0%; 33/97), different guidelines for different diseases (32.0%; 31/97), time-consuming to read guidelines (21.6%; 21/97), disagreements between different guideline recommendations (20.0%; 19/97), conflict with criteria for government subsidy (17.5%; 17/97) and GPs' busy schedules (15.5%; 15/97). When assessing patients' risk of stroke (n = 112) and bleeding (n = 111), the majority of the respondents reported primarily relying on a formal stroke risk (67.0%) and bleeding risk (55.0%) assessment tools, respectively. Respondents reported using formal stroke and bleeding risk assessment tools mainly when newly initiating patients on therapy (72.4%; 76/105 and 65.3%; 65/101, respectively). CONCLUSION: Among our small sample of Australian GPs, most did not access thromboprophylaxis-related information directly from AF-specific clinical guidelines developed by cardiology societies. Although the majority reported using formal stroke and bleeding assessment tools, these were typically used on OAC initiation only. More focus is needed on formal risk reassessment as clinically indicated and at regular review.
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Gebreyohannes et al. (2022) conducted a cross-sectional in Atrial fibrillation. Clinical guidelines and risk stratification tools was evaluated on Self-reported use of AF clinical guidelines and risk stratification tools. A survey of Australian general practitioners found that 67.0% rely on formal stroke risk tools and 55.0% on bleeding risk tools, primarily when newly initiating oral anticoagulants.
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