Abstract
BackgroundAs a large number of Community Health Service (CHS) centers in China face the majority of patients with non-valvular atrial fibrillation (NVAF), primary care physicians (PCPs) play a primary role in the prevention of embolization. Therefore, an awareness of anticoagulant management in patients with NVAF must be brought into focus among PCPs in China. This study investigated PCPs’ knowledge, attitudes, and practices toward anticoagulant therapy in patients with NVAF, to help them understand their shortcomings regarding oral anticoagulant (OAC) therapy in preventing embolization.MethodThis was a cross-sectional observational study of 462 PCPs in CHS centers across Shanghai. We used a self-administered questionnaire to collect data from September to December 2017. A stratified random cluster sampling was adopted in the 90 CHS centers with the family medicine residency program.ResultAmong 462 participants, 69.3% (320/462) of females received a medical bachelor’s degree and over 50% of participants had more than 10 years of work experience. Each section for knowledge, attitude, and practice were categorized as poor (≤39.0%), fair (40.0–69.0%), and good (≥70.0%). The level of knowledge of OAC therapy for patients with NVAF among PCPs was insufficient in over half (75.8%) of the participants. The majority (89.8%) of PCPs had a positive attitude and 68.0% had modest performance in the anticoagulant management of patients with NVAF.ConclusionsThe knowledge and behaviors of PCPs were insufficient for OAC therapy to prevent embolization in patients with NVAF. The study also revealed that there is good potential for PCPs’ educational interventions to positively impact the care of patients with NVAF.
Highlights
As a large number of Community Health Service (CHS) centers in China face the majority of patients with non-valvular atrial fibrillation (NVAF), primary care physicians (PCPs) play a primary role in the prevention of embolization
The knowledge and behaviors of PCPs were insufficient for oral anticoagulant (OAC) therapy to prevent embolization in patients with NVAF
With regard to OAC therapy, we found that 41.6% of PCPs treated NVAF with aspirin in more than 70% of their patients, while only 0.4% of PCPs treated NVAF with OAC in more than 70% of their patients
Summary
As a large number of Community Health Service (CHS) centers in China face the majority of patients with non-valvular atrial fibrillation (NVAF), primary care physicians (PCPs) play a primary role in the prevention of embolization. According to the 2010 Global Burden of Disease Study, the number of patients with AF worldwide was 33 million, of which more than 13% were over 80 years of age [2]. The burden of AF and associated strokes in China have increased significantly in recent years. More than 24.8% of patients with AF in China have suffered ischemic strokes [3], and patients with AF with stroke are generally characterized by high morbidity, mortality, disability, and recurrence rates. These features make anticoagulant therapy a high priority for stroke-prevention strategies of AF [6, 7]
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