Abstract 12882: Provider Rather Than Patient Misperceptions Appear to be the Most Common Barriers to Oral Anticoagulation Use for Stroke Prevention in Atrial Fibrillation

• Published in: Circulation (New York, N.Y.) N.Y.), 2016-11, Vol.134 (Suppl_1 Suppl 1), p.A12882-A12882
• Main Authors: Pokorney, Sean D, Granger, Christopher B, Bloom, Diane, Thomas, Kevin L, Al-Khatib, Sana M, Anderson, John, Heflin, Mitchell T, Granger, Bradi B
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.134.suppl_1.12882

IntroductionAtrial fibrillation (AF) is associated with increased risk of stroke, yet 50% of patients at high risk are not treated with guideline recommended oral anticoagulants (OACs). This qualitative analysis explored the barriers to OAC use from both physician and patient perspectives.MethodsPatients (n=25) from academic and community care settings with AF and CHA2DS2-VASc score ≥ 2 were included with a maximum variation sampling strategy for patients on OAC (n=13) and not on OAC (n=12). Provider sampling (n=25) included community primary care providers (n=15), academic geriatricians (n=5), and cardiologists (n=5) caring for the patient cohort. Semi-structured qualitative interviews were conducted with both groups focusing on perceptions of stroke risk and OAC use. Provider interviews used 3 standard AF cases to ascertain how stroke and bleeding risks affected OAC recommendation. Interviews continued until saturation of themes was achieved. Content analysis identified and coded dominant themes.ResultsA major theme was missing evidence of shared decision-making for OAC use. A majority of patients “took what was prescribed.” Nearly all physicians reported fall and bleeding risks as the primary reasons for not recommending OACs, but patients reported no communication with their physicians about falls or bleeding risk, other than in the setting of prior bleeding (Table). A second major theme was the knowledge gap in the lack of efficacy of aspirin for stroke prevention and the need for OAC in patients with infrequent or mildly symptomatic AF. Physicians (92%) understood that infrequent AF episodes required OAC, but in 33% of cases, patients with infrequent AF episodes were told that OACs were not warranted (Table).ConclusionsThese findings suggest that provider rather than patient concerns prevent appropriate OAC. Opportunities exist, particularly among non-cardiology providers, to increase the appropriate OAC use for AF patients at risk of stroke.