What are the differences between physician and patient expectation with regard to the management of atrial fibrillation?

BACKGROUND: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, with approximately 840,000 people suffering from it nationally. People with AF have an increased risk of stroke which can be mitigated effectively with the use of anticoagulant therapy. Nevertheless, evidence suggests that less than 50% of eligible patients are receiving this form of intervention. METHOD: A comprehensive literature search was undertaken to assess the published evidence in order to understand why clinicians and patients underutilize an effective intervention such as anticoagulation in favor of the less effective antiplatelet agents. RESULTS: The decision to use anticoagulant drugs in patients with AF involves a consideration of the potential benefits versus the risks, inconveniences, and costs. There is however widespread variation in the importance placed on these factors across primary care practices, individual doctors and between and within different patient groups. There is a paucity of literature designed to examine patient expectations. Available studies suggest that patients are prepared to be placed at a higher risk of bleeding than their prescribing doctors would be prepared to accept. Given that this judgement depends on a range of factors, it is not surprising that attempts to understand clinician's barriers to prescribing take precedence. CONCLUSION: The barriers to anticoagulation can be identified, but we still don't understand the importance that clinicians and individuals give them. These barriers continue to limit the use of anticoagulation therapy, a potentially beneficial treatment. Due to these limitations it is unclear what impact the increased range of oral anticoagulants and the alternation to the Quality and Outcomes Framework (QoF) will have on the incentive to primary care physicians to anticoagulate those at risk.