Geriatricians Show Knowledge Gaps in AF Anticoagulant Use
New Study Highlights Need for Enhanced Training in China
Geriatric specialists in China demonstrate a concerning deficit in knowledge regarding the use of oral anticoagulants for patients with atrial fibrillation (AF). While their attitudes and practices appear positive, critical knowledge gaps persist, potentially impacting patient care.
Study Reveals Key Knowledge Deficiencies
A recent web-based survey involving 210 geriatricians in China found that a significant portion struggled with crucial aspects of anticoagulant therapy for older adults with AF. For instance, nearly 43% mistakenly believed aspirin was a suitable stroke risk management tool for these patients. Research indicates aspirin is considerably less effective than anticoagulants for most AF patients with stroke risk factors.
Understanding Physician Perspectives
The study, which evaluated knowledge, attitudes, and practices (KAP), identified specific areas where geriatricians’ understanding was weaker. The question on assessing stroke and bleeding risks and considering medication use had the lowest correct response rate at just 27.1%. Conversely, most geriatricians (98.6%) correctly identified the need for individualized AF management in older adults with multiple comorbidities and medications.
Attitudes and Practices Generally Positive
Despite knowledge gaps, the survey indicated that geriatricians generally hold favorable attitudes towards anticoagulant therapy. A substantial 85.2% strongly agreed that patients should be regularly reassessed for stroke and bleeding risks and involved in treatment decisions. In practice, an overwhelming 95.1% of participating physicians reported prescribing anticoagulants.
Factors Influencing Knowledge
Multivariable analysis revealed that younger physicians (≤ 40 years), those practicing outside of Beijing, and those in non-public tertiary hospitals were more likely to exhibit poorer knowledge scores regarding oral anticoagulants. This suggests a need for targeted educational initiatives in these demographics.
The Role of Experience and Continuous Education
The study also found that a higher level of knowledge was positively linked to favorable attitudes towards anticoagulation therapy. However, an inverse relationship was observed between knowledge and proactive practice, a finding the researchers suggest may stem from experience overriding guideline-based knowledge. Continuous medical education, including seminars and online resources, is recommended to bridge these knowledge gaps, particularly for younger practitioners.
Addressing Prescription Patterns
In terms of specific drug choices, approximately 56.5% of participants recommended rivaroxaban, with the most common prescribed daily dose being 15 mg. However, these practical choices need to be grounded in comprehensive knowledge to ensure optimal patient outcomes.
Broader Implications for Geriatric Care
Geriatricians often prioritize a patient’s functional status, recognizing its significant impact on health and treatment decisions. This perspective is crucial when managing anticoagulation in older adults, who may have complex needs due to frailty, cognitive impairment, or a higher risk of falls and bleeding. Collaborative care planning involving multidisciplinary teams is essential.
Future Directions and Limitations
While the study provides valuable insights, its limitations include the self-designed nature of the questionnaire, potential recall or social desirability bias in self-reported data, and the lack of external validation. Future research should explore how specific knowledge translates into clinical performance and patient outcomes.
Conclusion
The findings highlight a critical need to strengthen the knowledge base of Chinese geriatricians concerning oral anticoagulants for AF patients. Targeted educational programs focusing on younger physicians and those in less-resourced settings could significantly improve the management of this common condition in the elderly.
