Investigation on the use of warfarin in the prevention of stroke in patients with non-valvular atrial fibrillation among physicians from county-level hospitals

Abstract:

Objective：To investigate the prevalence of the use of warfarin in prevention of stroke in non-valvular atrial fibrillation （NVAF） among physicians from county-level hospitals. Methods：A cross-sectional questionnaire survey was conducted in 292 physicians who were chosen randomly from 9 county-level hos－pitals. The questionnaire mainly consisted of the following con－tents：problems affecting the prescribing of warfarin by physi－cians and the administration of the use of warfarin in patients with NVAF. Results：From June to November in 2013，292 ques－tionnaires were collected and 208（72.2%） of them were analyzed. Around 11.5%（24） of physicians strongly agreed that “they often were not sure 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 or CHA2DS2-VASC score≥2，only 22.1%（46）（case3），19.2%（40）（case4），34.1%（71）（case5） and 21.2%（44）（case12）of physicians prescribed warfarin for the prevention of stroke. In patients with HAS-BLED score≥3patients，only 8.2%（17）（case6），10.6%（22）（case7） and 9.1%（19）（case8） of physicians pre－scribed warfarin for the prevention of stroke in NVAF. Conclusion：This study highlights the deficiency of knowledge regarding the risk stratification and anticoagulant treatment about NVAF 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 appear to be the biggest barriers for anticoagulant in NVAF. Educational programs are needed to improve the situation of the right use of warfarin in NVAF patients.