| Objective:Warfarin was underused in Chinese patients with atrial fibrillation (AF). The purpose of this survey was to investigate the perceptions of the prevention of stroke and warfarin in physicians from county-level hospitals.Methods:This study was a cross-sectional survey. From Jun to Nov in 2013,292 physicians from 9 hospitals of Jiangsu, Henan, Zhejiang, Jiangxi provinces were randomly enrolled into the current study. A standard questionnaire survey, which consisted of questions on physicians’ knowledge, problems affecting the prescribing of warfarin by physicians and the administration of the use of warfarin in patients with NVAF and the awareness and concerns regarding atrial fibrillation diagnosis and warfarin treatment, was administered to each of them.Results:292 questionnaires were returned and 208 of them were finally analyzed. According to the reports of the physicians, the percentage of anticoagulant treatment was 30.0%(10.0%～60.0%) in patients with rheumatic valvular AF,20.0%(10.0%-50.0%) in patients with non valvular AF and 80.0%(40.0%～100.0%) in those with post mechanical heart valve replacement. Around 11.5%(24) of physicians strongly agreed that "they often were not sure that whether or not to prescribe warfarin". 20.2%(42) of physicians strongly agreed that "they fully understood their patients’views on the benefits and risks of warfarin". In patients with CHADS2 score(?)2 or CHA2DS2-VASc score(?)2, only 22.1%(46) (case3), 19.2%(40) (case4),34.1%(71) (case5) and 21.2%(44) (casel2) of physicians prescribed warfarin for the prevention of stroke. In patients with HAS-BLED score(?)3, only 8.2%(17) (case6),10.6%(22) (case7) and 9.1%(19) (case8) of physicians prescribed warfarin for the prevention of stroke in NVAF. The most common concerns of prescribing warfarin were worries about the bleeding adverse reactions related to warfarin (74.0%, 154), the necessary to monitoring INR (65.4%,136) and advanced age (44.7%,93). A half of the patients with AF were diagnosed with normal electrocardiogram (ECG) and only 28.3%(59) of them were diagnosed with both ECG and Holter. Among the physicians who reported using INR to monitor warfarin,62.5%(130) reported a target ranging from 2 and 3 and one third of the participants reported lower target of INR than 2. The proportion of the physicians who were aware of CHADS2 score and CHA2DS2-VASC score were 51.0%(106) and 41.3%(86), respectively. However, those really knowing the risk factors consisted in CHADS2 score and CHA2DS2-VASC score only accounted for 15.4%(32) and 6.3%(13) respectively. Although 34.6%(72) of the physicians were aware of HAS-BLED score, only 5.3%(11) correctly selected the 9 parameters about it.68.3%(142) of the physicians reported that the Vitamin K is the antidote for warfarin.Conclusions:This study highlighted the deficiency of knowledge regarding the risk stratification and anticoagulant treatment about AF in physicians from county-level hospitals. Decisional conflicts of the use of warfarin in the prevention of stroke and being not able to evaluate the benefits and risks brought by warfarin patients appeared to be the biggest barriers for anticoagulant in AF. Concerns about the risks of bleeding and INR monitoring is likely to be the biggest barriers for anticoagulant treatment. Education program are needed to boost the prevalence of the right use of warfarin in patients with AF for physician from county-level hospitals. |
PDF Full Text Request