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2015 ; 8
(11
): 357-67
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gab.com Text
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Contemporary approaches to managing atrial fibrillation: A survey of Australian
general practitioners
#MMPMID26688698
Bajorek B
; Magin P
; Hilmer S
; Krass I
Australas Med J
2015[]; 8
(11
): 357-67
PMID26688698
show ga
BACKGROUND: Recent attention to the management of atrial fibrillation (AF) and
stroke prevention has emphasised the need to support the use of existing
pharmacotherapy through available services and resources, in preference to using
the new, more expensive, novel oral anticoagulants. In this regard, general
practitioners (GPs) are at the core of care. AIMS: To survey Australian GPs
regarding their approach to managing AF, particularly in relation to stroke
prevention therapy, and to identify the range of services to support patient
care. METHODS: A structured questionnaire, comprising quantitative and
qualitative responses, was administered to participating GPs within four
geographical regions of NSW (metropolitan, regional, rural areas). RESULTS: Fifty
GPs (mean age 53.74±9.94 years) participated. Most (98 per cent) GPs regarded
themselves as primarily responsible for the management of AF, only referring
patients to specialists when needed. However, only 10 per cent of GPs specialised
in "heart/vascular health". Most (76 per cent) GPs offered point-of-care
international normalised ratio (INR) testing, with 90 per cent also offering
patient support via practice nurses and home visits. Overall, key determinants
influencing GPs' initiation of antithrombotic therapy were: "stroke risk"/"CHADS2
score", followed by "patients' adherence/compliance". GPs focused more on
medication safety considerations and the day-to-day management of therapy than on
the risk of bleeding. CONCLUSION: Australian GPs are actively engaged in managing
AF, and appear to be well resourced. Importantly, there is a greater focus on the
benefits of therapy during decision-making, rather than on the risks. However,
medication safety considerations affecting routine management of therapy remain
key concerns, with patients' adherence to therapy a major determinant in
decision-making.