English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Plus monthly

Global: Zendy Tools annual

Global: Zendy Tools monthly

Global: Zendy Free Plan

The factors influencing oral anticoagulant (OAC) prescription for atrial fibrillation (AF) are not well understood. Novel oral anticoagulants (NOACs) have increased treatment options and complicated the decision making process for patients with AF. Prior studies identified factors predicting selection of NOACs over warfarin; however, prescriber knowledge and beliefs underlying these practices have not been evaluated. We sought to evaluate prescriber beliefs and trial interpretations influencing OAC prescription across specialties. We conducted an anonymous, online survey with 9 multiple choice questions (Table 1). This study was approved by the Institutional Review Board (IRB) at Beth Israel Deaconess Medical Center. The first question asked respondents to identify their specialty and practice setting. The remaining questions explored beliefs and understanding of the medical literature. The survey was pilot tested on a focus group to assess understandability, length, and validity before broader distribution. The survey was administered using a secure, web-based application (www.SurveyMonkey.com). Participants were invited by e-mail and were contacted up to 3 times to complete the consent and survey. We distributed the survey to 204 internists (hospital-based and community primary care physicians, hospitalists) and 42 cardiologists associated with Beth Israel Deaconess Medical Center and 185 Vascular Neurologists at U.S. academic medical centers. Responses to survey questions were stratified by specialty. Comparisons between proportions of responses were analyzed with the Chi-square test with α=0.05. To account for multiple comparisons, a Bonferroni corrected P-value of 0.0035 is presented (significance denoted by * in the Results section). 128 of 431 potential participants (30%) completed the survey (58 of 204 Internists, 16 of 42 Cardiologists, 54 of 185 Vascular Neurologists). Among internists, there were 22 community primary care physicians, 29 hospital-based primary care physicians, and 7 hospitalists. Interpretation of the term “stroke” varied, though not between specialties: a majority in each specialty (60% internists, 69% cardiologists, 83% neurologists, P=0.027) selected a broad definition including ischemic stroke (IS) and several forms of hemorrhage. A minority (31% internists, 31% cardiologists, 17% neurologists, P=0.18) selected a definition limited to IS. When prescribing anticoagulation, most (66%) were primarily concerned with IS prevention efficacy (60% internists, 69% cardiologists, 70% neurologists, P=0.52) instead of safety, cost, or ease of reversal. There were no major differences between specialties regarding concern about major bleeding risk with warfarin (13% cardiologists, 36% internists, 31% neurologists) (P=0.19). Regarding combining warfarin with aspirin, neurologists (70%) were more likely (P=0.00028*) to consider warfarin sufficient for patients with AF and coronary artery disease without stents or to avoid combining medications as compared to internists (40%) or cardiologists (25%). Internists (45%) and cardiologists (56%) frequently prescribed this combination despite their concerns about bleeding risk; this was uncommon among neurologists (15%) (P=0.00043*). Regarding the comparative efficacy of NOACs and warfarin, all specialties were equally likely to be unaware that only dabigatran has demonstrated superiority compared to warfarin in IS prevention in clinical trials: some internists (45%), cardiologists Factors Influencing Oral Anticoagulant Prescribing Practices for Atrial Fibrillation