National Physician Survey for Nonvalvular Atrial Fibrillation (NVAF) Anticoagulation Comparing Knowledge, Attitudes and Practice of Cardiologist to PCPs
Introduction: NVAF is estimated to affect between 6.4 and 7.4 million Americans in 2018, and increases the risk of stroke 5-fold. To mitigate this risk, guidelines recommend anticoagulating AF patients unless their stroke risk is very low. Despite these recommendations, 30.0-60.0% of NVAF patients d...
| Main Authors: | , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2020-10-01
|
| Series: | Clinical and Applied Thrombosis/Hemostasis |
| Online Access: | https://doi.org/10.1177/1076029620952550 |
| _version_ | 1819205850577764352 |
|---|---|
| author | Haseeb Saeed MD Oscar Garza Ovalle MD Ujala Bokhary MBBS Anastasia Jermihov BS Kamila Lepkowska MHA Victoria Bauer BS Kristine Kuchta MS Marcia Wright PharmD Scott Glosner BS, PharmD, BCPS, MPH Margaret Frazer MD Andres Quintero MD, MPH, MBA Patrick Hlavacek MPH Jack Mardekian PhD Alfonso Tafur MD Mark Metzl MD Jorge Saucedo MD |
| author_facet | Haseeb Saeed MD Oscar Garza Ovalle MD Ujala Bokhary MBBS Anastasia Jermihov BS Kamila Lepkowska MHA Victoria Bauer BS Kristine Kuchta MS Marcia Wright PharmD Scott Glosner BS, PharmD, BCPS, MPH Margaret Frazer MD Andres Quintero MD, MPH, MBA Patrick Hlavacek MPH Jack Mardekian PhD Alfonso Tafur MD Mark Metzl MD Jorge Saucedo MD |
| author_sort | Haseeb Saeed MD |
| collection | DOAJ |
| description | Introduction: NVAF is estimated to affect between 6.4 and 7.4 million Americans in 2018, and increases the risk of stroke 5-fold. To mitigate this risk, guidelines recommend anticoagulating AF patients unless their stroke risk is very low. Despite these recommendations, 30.0-60.0% of NVAF patients do not receive indicated anticoagulation. To better understand why this may be, we surveyed PCPs and cardiologists nationwide on their attitudes, knowledge and practices toward managing NVAF with warfarin and direct-acting oral anticoagulants (DOACs). Methods: We surveyed 1,000 PCPs and 500 cardiologists selected randomly from a master list of the American Medical Association, using a paper based, anonymous, self-administered, mailed scannable survey. The survey contained questions on key demographics and data concerning attitudes, knowledge and practices related to prescribing DOACs. The surveys went out in the fall/winter of 2017-8 with a $10 incentive gift card. Survey responses were scanned into an Excel database and analyzed using SAS 9.3 (Cary, NC) for descriptive and inferential statistics. Results: Two hundred and forty-nine providers (167 PCPs, 82 cardiologists) participated in the study with a response rate of 18.8% (249/1320). Respondent mean years ±SD of experience since completing residency was 23.2 ± 13.8. Relative to cardiologists, less PCPs use CHADsVASC (36.8% vs. 74.4%) (p < 0.0001); more have never used HAS-BLED, HEMORR2HAGES, or ATRIA (38.5% vs. 9.8%) (p < .0001); more felt that their lack of knowledge/experience with DOACs was a barrier to prescribing the agents (p = 0.005); and more reported that they could use additional education on DOACs (87.0% vs. 47.0%) (p < 0.0001). Overall, cardiologists were more concerned about ischemic stroke outcomes, while PCPs were more concerned with GI bleeding. Cardiologists also felt that clinical trial data were most helpful in choosing the most appropriate DOAC for their patients, while PCPs felt that Real World Data was most useful. Conclusions: Cardiologists were more concerned with ischemic stroke while anticoagulating patients and utilized screening instruments like CHADsVASC in a majority of their patients. PCPs were concerned with GI bleeds when anticoagulating but nearly 40.0% utilized no screening tools to assess bleeding risk. Our findings show that future education about DOACs would be warranted especially with PCPs. |
| first_indexed | 2024-12-23T04:58:15Z |
| format | Article |
| id | doaj.art-2930a43ddf654bccaf3b68c11718c7ac |
| institution | Directory Open Access Journal |
| issn | 1938-2723 |
| language | English |
| last_indexed | 2024-12-23T04:58:15Z |
| publishDate | 2020-10-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Clinical and Applied Thrombosis/Hemostasis |
| spelling | doaj.art-2930a43ddf654bccaf3b68c11718c7ac2022-12-21T17:59:17ZengSAGE PublishingClinical and Applied Thrombosis/Hemostasis1938-27232020-10-012610.1177/1076029620952550National Physician Survey for Nonvalvular Atrial Fibrillation (NVAF) Anticoagulation Comparing Knowledge, Attitudes and Practice of Cardiologist to PCPsHaseeb Saeed MD0Oscar Garza Ovalle MD1Ujala Bokhary MBBS2Anastasia Jermihov BS3Kamila Lepkowska MHA4Victoria Bauer BS5Kristine Kuchta MS6Marcia Wright PharmD7Scott Glosner BS, PharmD, BCPS, MPH8Margaret Frazer MD9Andres Quintero MD, MPH, MBA10Patrick Hlavacek MPH11Jack Mardekian PhD12Alfonso Tafur MD13Mark Metzl MD14Jorge Saucedo MD15 Pfizer Inc, New York, NY, USA Pfizer Inc, New York, NY, USA Pfizer Inc, New York, NY, USA Pfizer Inc, New York, NY, USA Pfizer Inc, New York, NY, USA Pfizer Inc, New York, NY, USA Pfizer Inc, New York, NY, USA Pfizer Inc, New York, NY, USA Pfizer Inc, New York, NY, USA Pfizer Inc, New York, NY, USA Pfizer Inc, New York, NY, USA Pfizer Inc, New York, NY, USA Pfizer Inc, New York, NY, USA Pfizer Inc, New York, NY, USA Pfizer Inc, New York, NY, USA Pfizer Inc, New York, NY, USAIntroduction: NVAF is estimated to affect between 6.4 and 7.4 million Americans in 2018, and increases the risk of stroke 5-fold. To mitigate this risk, guidelines recommend anticoagulating AF patients unless their stroke risk is very low. Despite these recommendations, 30.0-60.0% of NVAF patients do not receive indicated anticoagulation. To better understand why this may be, we surveyed PCPs and cardiologists nationwide on their attitudes, knowledge and practices toward managing NVAF with warfarin and direct-acting oral anticoagulants (DOACs). Methods: We surveyed 1,000 PCPs and 500 cardiologists selected randomly from a master list of the American Medical Association, using a paper based, anonymous, self-administered, mailed scannable survey. The survey contained questions on key demographics and data concerning attitudes, knowledge and practices related to prescribing DOACs. The surveys went out in the fall/winter of 2017-8 with a $10 incentive gift card. Survey responses were scanned into an Excel database and analyzed using SAS 9.3 (Cary, NC) for descriptive and inferential statistics. Results: Two hundred and forty-nine providers (167 PCPs, 82 cardiologists) participated in the study with a response rate of 18.8% (249/1320). Respondent mean years ±SD of experience since completing residency was 23.2 ± 13.8. Relative to cardiologists, less PCPs use CHADsVASC (36.8% vs. 74.4%) (p < 0.0001); more have never used HAS-BLED, HEMORR2HAGES, or ATRIA (38.5% vs. 9.8%) (p < .0001); more felt that their lack of knowledge/experience with DOACs was a barrier to prescribing the agents (p = 0.005); and more reported that they could use additional education on DOACs (87.0% vs. 47.0%) (p < 0.0001). Overall, cardiologists were more concerned about ischemic stroke outcomes, while PCPs were more concerned with GI bleeding. Cardiologists also felt that clinical trial data were most helpful in choosing the most appropriate DOAC for their patients, while PCPs felt that Real World Data was most useful. Conclusions: Cardiologists were more concerned with ischemic stroke while anticoagulating patients and utilized screening instruments like CHADsVASC in a majority of their patients. PCPs were concerned with GI bleeds when anticoagulating but nearly 40.0% utilized no screening tools to assess bleeding risk. Our findings show that future education about DOACs would be warranted especially with PCPs.https://doi.org/10.1177/1076029620952550 |
| spellingShingle | Haseeb Saeed MD Oscar Garza Ovalle MD Ujala Bokhary MBBS Anastasia Jermihov BS Kamila Lepkowska MHA Victoria Bauer BS Kristine Kuchta MS Marcia Wright PharmD Scott Glosner BS, PharmD, BCPS, MPH Margaret Frazer MD Andres Quintero MD, MPH, MBA Patrick Hlavacek MPH Jack Mardekian PhD Alfonso Tafur MD Mark Metzl MD Jorge Saucedo MD National Physician Survey for Nonvalvular Atrial Fibrillation (NVAF) Anticoagulation Comparing Knowledge, Attitudes and Practice of Cardiologist to PCPs Clinical and Applied Thrombosis/Hemostasis |
| title | National Physician Survey for Nonvalvular Atrial Fibrillation (NVAF) Anticoagulation Comparing Knowledge, Attitudes and Practice of Cardiologist to PCPs |
| title_full | National Physician Survey for Nonvalvular Atrial Fibrillation (NVAF) Anticoagulation Comparing Knowledge, Attitudes and Practice of Cardiologist to PCPs |
| title_fullStr | National Physician Survey for Nonvalvular Atrial Fibrillation (NVAF) Anticoagulation Comparing Knowledge, Attitudes and Practice of Cardiologist to PCPs |
| title_full_unstemmed | National Physician Survey for Nonvalvular Atrial Fibrillation (NVAF) Anticoagulation Comparing Knowledge, Attitudes and Practice of Cardiologist to PCPs |
| title_short | National Physician Survey for Nonvalvular Atrial Fibrillation (NVAF) Anticoagulation Comparing Knowledge, Attitudes and Practice of Cardiologist to PCPs |
| title_sort | national physician survey for nonvalvular atrial fibrillation nvaf anticoagulation comparing knowledge attitudes and practice of cardiologist to pcps |
| url | https://doi.org/10.1177/1076029620952550 |
| work_keys_str_mv | AT haseebsaeedmd nationalphysiciansurveyfornonvalvularatrialfibrillationnvafanticoagulationcomparingknowledgeattitudesandpracticeofcardiologisttopcps AT oscargarzaovallemd nationalphysiciansurveyfornonvalvularatrialfibrillationnvafanticoagulationcomparingknowledgeattitudesandpracticeofcardiologisttopcps AT ujalabokharymbbs nationalphysiciansurveyfornonvalvularatrialfibrillationnvafanticoagulationcomparingknowledgeattitudesandpracticeofcardiologisttopcps AT anastasiajermihovbs nationalphysiciansurveyfornonvalvularatrialfibrillationnvafanticoagulationcomparingknowledgeattitudesandpracticeofcardiologisttopcps AT kamilalepkowskamha nationalphysiciansurveyfornonvalvularatrialfibrillationnvafanticoagulationcomparingknowledgeattitudesandpracticeofcardiologisttopcps AT victoriabauerbs nationalphysiciansurveyfornonvalvularatrialfibrillationnvafanticoagulationcomparingknowledgeattitudesandpracticeofcardiologisttopcps AT kristinekuchtams nationalphysiciansurveyfornonvalvularatrialfibrillationnvafanticoagulationcomparingknowledgeattitudesandpracticeofcardiologisttopcps AT marciawrightpharmd nationalphysiciansurveyfornonvalvularatrialfibrillationnvafanticoagulationcomparingknowledgeattitudesandpracticeofcardiologisttopcps AT scottglosnerbspharmdbcpsmph nationalphysiciansurveyfornonvalvularatrialfibrillationnvafanticoagulationcomparingknowledgeattitudesandpracticeofcardiologisttopcps AT margaretfrazermd nationalphysiciansurveyfornonvalvularatrialfibrillationnvafanticoagulationcomparingknowledgeattitudesandpracticeofcardiologisttopcps AT andresquinteromdmphmba nationalphysiciansurveyfornonvalvularatrialfibrillationnvafanticoagulationcomparingknowledgeattitudesandpracticeofcardiologisttopcps AT patrickhlavacekmph nationalphysiciansurveyfornonvalvularatrialfibrillationnvafanticoagulationcomparingknowledgeattitudesandpracticeofcardiologisttopcps AT jackmardekianphd nationalphysiciansurveyfornonvalvularatrialfibrillationnvafanticoagulationcomparingknowledgeattitudesandpracticeofcardiologisttopcps AT alfonsotafurmd nationalphysiciansurveyfornonvalvularatrialfibrillationnvafanticoagulationcomparingknowledgeattitudesandpracticeofcardiologisttopcps AT markmetzlmd nationalphysiciansurveyfornonvalvularatrialfibrillationnvafanticoagulationcomparingknowledgeattitudesandpracticeofcardiologisttopcps AT jorgesaucedomd nationalphysiciansurveyfornonvalvularatrialfibrillationnvafanticoagulationcomparingknowledgeattitudesandpracticeofcardiologisttopcps |