Psychological barriers, such as fear of falls or prior bleeding, significantly limit the prescription of anticoagulation for nonvalvular atrial fibrillation by family physicians.
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May indicate under-prescription of anticoagulation in high-risk AF with perceived bleeding risks; hypothesis-generating for interventions targeting physician barriers.
BACKGROUND AND PURPOSE: Anticoagulation reduces the risk of stroke in nonvalvular atrial fibrillation yet remains underused. We explored barriers to the use of anticoagulants among Australian family physicians. METHODS: The authors conducted a representative, national survey. RESULTS: Of the 596 (64.4%) eligible family physicians who participated, 15.8% reported having a patient with nonvalvular atrial fibrillation experience an intracranial hemorrhage with anticoagulation and 45.8% had a patient with known nonvalvular atrial fibrillation experience a stroke without anticoagulation. When presented with a patient at "very high risk" of stroke, only 45.6% of family physicians selected warfarin in the presence of a minor falls risk and 17.1% would anticoagulate if the patient had a treated peptic ulcer. Family physicians with less decisional conflict and longer-standing practices were more likely to endorse anticoagulation. CONCLUSIONS: Strategies to optimize the management of nonvalvular atrial fibrillation should address psychological barriers to using anticoagulation.
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Gattellari et al. (2007) studied this question.
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