Anticoagulation for Atrial Fibrillation: Physicians’ Readiness to Change Practices
PURPOSE.Determine physicians’ readiness to change anticoagulation practices for patients with non-valvular atrial fibrillation (NVAF). BACKGROUND. Only half of eligible NVAF patients receive warfarin. Interventions to alter physicians’ anticoagulation practices must consider their motivation to change. METHODS. As part of a US national survey (1993–94), physicians were asked their current practices for patients over age 65 with NVAF, and whether they were comfortable, considering change, or expecting to change those practices. RESULTS. Overall, 67% of eligible physicians fully responded to the survey (n=1006). Seventy-three percent (72% of non-internist primary care physicians [PCPs], 76% of internists, 69% of neurologists and 37% of surgeons) responded that they often or always anticoagulate patients over age 65 with NVAF. The majority (73%) indicated they were comfortable with their practices, with the rates differing by specialty (68% PCPs, 76% internists, 82% neurologists, 87% surgeons; p<0.001). Regardless of specialty, 78% of physicians who seldom or never anticoagulate this type of patient were comfortable with this practice. An identical proportion of physicians indicating they always or often use anticoagulants for patients with NVAF were comfortable with their practices. CONCLUSION. Although differing by specialty, these data show that the majority of physicians are not expecting or planning to change their anticoagulation practices for patients over age 65 with NVAF. Although the majority believe they anticoagulate such patients and are comfortable with their practices, their actual treatment patterns may differ as several studies show that high proportions of eligible AF patients do not receive warfarin. Utilization review coupled with the identification of specific practice barriers and tailored educational programs may address this discrepancy. A high proportion of physicians who responded that they seldom or never anticoagulate these patients were also comfortable with their practices. Providing current treatment guidelines reinforced by other educational strategies might motivate them to consider a change in practice.