Published Online
on November 29, 2007

A more recent version of this article appeared on January 1, 2008

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Submitted on May 29, 2007
Accepted on June 7, 2007

Barriers to the Use of Anticoagulation for Nonvalvular Atrial Fibrillation. A Representative Survey of Australian Family Physicians

Melina Gattellari PhD^*; John Worthington MBBS; Nicholas Zwar PhD; and Sandy Middleton PhD

From the School of Public Health and Community Medicine (M.G.), The University of New South Wales and the Centre for Research Management, Evidence and Surveillance, Sydney South West Area Health Service, Liverpool, Australia; Sydney South West Area Health Service and Stroke and Neurology Services (J.W.), Northern Beaches Hospitals, Liverpool; the School of Public Health and Community Medicine (N.Z.), The University of New South Wales, and the GP Unit, Fairfield, Sydney South West Area Health Service; and the School of Nursing (NSW and ACT) (S.M.), Australian Catholic University, North Sydney.

^* To whom correspondence should be addressed. E-mail: Melina.Gattellari{at}sswahs.nsw.gov.au.

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.

Conclusion—Strategies to optimize the management of nonvalvular atrial fibrillation should address psychological barriers to using anticoagulation.

Key words: atrial fibrillation • clinical practice • primary health care

Related Article:

Barriers to Anticoagulation in Patients With Atrial Fibrillation: Changing Physician-Related Factors

Deirdre A. Lane and Gregory Y.H. Lip
Stroke 2008 39: 7-9. [Extract] [Full Text] [PDF]

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