Department of Pharmacy, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Leslie Dan Faculty of Pharmacy, 144 College St, University of Toronto, Ontario M5S 3M2, Canada.
Department of Pharmacy, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Leslie Dan Faculty of Pharmacy, 144 College St, University of Toronto, Ontario M5S 3M2, Canada.
Thromb Res. 2021 Jun;202:176-181. doi: 10.1016/j.thromres.2021.04.004. Epub 2021 Apr 15.
Direct oral anticoagulants (DOACs) are prescribed for over 80% of patients who start anticoagulant therapy for a new diagnosis of atrial fibrillation (AF). Inappropriate DOAC prescriptions are associated with increased mortality. However, limited data exist as to what proportion of primary care physicians (PCPs) initiate anticoagulation in patients with new AF and the extent of their DOAC knowledge.
We conducted a telephone survey of randomly selected PCPs in Ontario, Canada. Our primary objective was to determine the percentage of PCPs who initiate anticoagulation in new AF patients and the proportion of patients they initiate on DOACs. Our secondary objectives were to assess PCPs' knowledge about DOACs and to identify educational opportunities to address any knowledge gaps.
Our survey included 50 respondents. After making a new AF diagnosis, 66% of PCPs stated that they usually initiate anticoagulation themselves and 84% prescribed a DOAC at least 75% of the time. Potential DOAC knowledge gaps included: administration considerations, off-label dosing, concomitant use of acetylsalicylic acid (ASA) in stable coronary artery disease (CAD) and use in valvular AF.
Most PCPs initiate anticoagulants for AF and prescribe DOACs for the vast majority of new patients. PCPs were well versed in certain aspects of DOAC prescribing, however, a number of knowledge gaps were identified. PCPs may benefit from targeted education in these areas to improve patient outcomes in AF.
对于新诊断为心房颤动（AF）的患者，超过 80%的患者开始接受抗凝治疗时会开直接口服抗凝剂（DOAC）。不适当的 DOAC 处方与死亡率增加有关。然而，关于初级保健医生（PCP）在新发 AF 患者中启动抗凝治疗的比例以及他们对 DOAC 知识的掌握程度，数据有限。
我们对加拿大安大略省的随机选择的 PCP 进行了电话调查。我们的主要目的是确定启动新 AF 患者抗凝治疗的 PCP 比例，以及他们启动 DOAC 的比例。我们的次要目标是评估 PCP 对 DOAC 的了解程度，并确定解决任何知识差距的教育机会。
我们的调查包括 50 名受访者。在做出新的 AF 诊断后，66%的 PCP 表示他们通常自己启动抗凝治疗，84%的人至少 75%的时间开 DOAC。潜在的 DOAC 知识差距包括：给药注意事项、超说明书剂量、稳定型冠心病（CAD）中同时使用乙酰水杨酸（ASA）和在瓣膜性 AF 中的使用。
大多数 PCP 会为 AF 启动抗凝治疗，并为绝大多数新患者开 DOAC。PCP 对 DOAC 处方的某些方面非常熟悉，但也发现了一些知识差距。PCP 可能受益于这些领域的有针对性的教育，以改善 AF 患者的预后。
