National Physician Survey for Nonvalvular Atrial Fibrillation (NVAF) Anticoagulation Comparing Knowledge, Attitudes and Practice of Cardiologist to PCPs.
National Physician Survey for Nonvalvular Atrial Fibrillation (NVAF) Anticoagulation Comparing Knowledge, Attitudes and Practice of Cardiologist to PCPs.
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DOI：
10.1177/1076029620952550
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发表时间：
2020-01
期刊：
影响因子：
--
通讯作者：
Saucedo J
中科院分区：
文献类型：
--
作者：
Saeed H;Ovalle OG;Bokhary U;Jermihov A;Lepkowska K;Bauer V;Kuchta K;Wright M;Glosner S;Frazer M;Quintero A;Hlavacek P;Mardekian J;Tafur A;Metzl M;Saucedo J
据估计，2018年NVAF将影响640万至740万美国人，并使中风风险增加5倍。为了减轻这种风险，指南建议抗房颤患者，除非他们的中风风险非常低。尽管有这些建议，但30.0-60.0%的NVAF患者未接受适用的抗凝治疗。为了更好地理解为什么会这样，我们在全国范围内调查了PCP和心脏病专家对华法林和直接作用口服抗凝剂（DOAC）管理NVAF的态度，知识和实践。我们调查了1,000名PCP和500名心脏病专家，他们是从美国医学协会的主名单中随机选择的，使用基于纸张的，匿名的，自我管理的，邮寄的可扫描调查。该调查包含关于关键人口统计学的问题和关于处方DOAC相关的态度、知识和实践的数据。这些调查在2017-8的秋季/冬季进行，并附有10美元的奖励礼品卡。将调查答复扫描到Excel数据库中，并使用SAS 9.3（卡里，NC）进行描述性和推断性统计分析。249名提供者（167名PCP，82名心脏病专家）参与了研究，应答率为18.8%（249/1320）。自完成住院医师培训以来，受访者的平均经验年数±SD为23.2 ± 13.8。相对于心脏病专家，较少PCP使用CHADsVASC（36.8% vs. 74.4%）（p < 0.0001）;更多的人从未使用过HAS-BLED、HEMORR 2 HAGES或ATRIA（38.5% vs. 9.8%）（p < .0001）;更多人认为他们缺乏DOAC知识/经验是处方药物的障碍（p = 0.005）;更多的人报告他们可以使用DOAC的额外教育（87.0% vs. 47.0%）（p < 0.0001）。总体而言，心脏病专家更关注缺血性卒中结局，而PCP更关注GI出血。心脏病专家还认为，临床试验数据在为患者选择最合适的DOAC方面最有帮助，而PCP认为真实的世界数据最有用。心脏病专家更关注缺血性卒中，而抗卒中患者，并在大多数患者中使用CHADsVASC等筛查工具。PCP关注抗糖尿病药物治疗时的胃肠道出血，但近40.0%的患者未使用筛查工具评估出血风险。我们的研究结果表明，未来的教育DOAC将是必要的，特别是与PCP。
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). 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. 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. 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.
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影响因子：
2.1
作者：
Johansson C;Hägg L;Johansson L;Jansson JH
通讯作者：
Jansson JH
影响因子：
168.9
作者：
Ruff, Christian T.;Giugliano, Robert P.;Antman, Elliott M.
通讯作者：
Antman, Elliott M.
影响因子：
3.8
作者：
McKenna, HP;Ashton, S;Keeney, S
通讯作者：
Keeney, S
影响因子：
37.8
作者：
Benjamin EJ;Blaha MJ;Chiuve SE;Cushman M;Das SR;Deo R;de Ferranti SD;Floyd J;Fornage M;Gillespie C;Isasi CR;Jiménez MC;Jordan LC;Judd SE;Lackland D;Lichtman JH;Lisabeth L;Liu S;Longenecker CT;Mackey RH;Matsushita K;Mozaffarian D;Mussolino ME;Nasir K;Neumar RW;Palaniappan L;Pandey DK;Thiagarajan RR;Reeves MJ;Ritchey M;Rodriguez CJ;Roth GA;Rosamond WD;Sasson C;Towfighi A;Tsao CW;Turner MB;Virani SS;Voeks JH;Willey JZ;Wilkins JT;Wu JH;Alger HM;Wong SS;Muntner P;American Heart Association Statistics Committee and Stroke Statistics Subcommittee
通讯作者：
American Heart Association Statistics Committee and Stroke Statistics Subcommittee
影响因子：
3.4
作者：
Loo, Simone Y.;Dell'Aniello, Sophie;Renoux, Christel
通讯作者：
Renoux, Christel