Stroke prevention and atrial fibrillation: reasons leading to an inappropriate management. Main results of the SAFE II study.
OBJECTIVE
The aim of the Stroke and Atrial Fibrillation Ensemble (SAFE) II study was to identify the reasons underlying the under-utilization of oral anticoagulation (OAC) in patients with nonvalvular atrial fibrillation (NVAF).


METHODS
We investigated from all available sources the reasons why patients hospitalized for a stroke, who had a previously known NVAF, were not receiving OAC beforehand. We interviewed general practitioners (GPs) and cardiologists with a structured questionnaire, to identify the reasons for their therapeutic choice.


RESULTS
Of 370 patients, 257 were theoretically eligible for OAC according to guidelines and the presence of contra-indications, but only 82 (22.2%) of them had actually received OAC before. We found that factors independently associated with the prescription of OAC were being followed-up by a cardiologist and having a younger GP. The leading reason evoked by GPs or cardiologists to explain why patients were not treated with OAC was the presence of a 'potential contra-indication', which was often inappropriate, followed by 'there was no indication', 'low compliance' and 'fear of bleeding'.


CONCLUSIONS
An important reason for not prescribing OAC was the lack of knowledge about trials and guidelines. Medical education about OAC in NVAF should therefore be improved.
Deplanque
Dominique
D
Department of Pharmacology, University of Lille, France. d-deplanque@chru-lille.fr
Leys
Didier
D
Parnetti
Lucilla
L
Schmidt
Reinhold
R
Ferro
Jose
J
De Reuck
Jacques
J
Mas
Jean-Louis
JL
Gallai
Virgilio
V
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D005060:Europe; D019983:Guideline Adherence; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006801:Humans; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D020521:Stroke / Q000517:prevention & control*
D000925:Anticoagulants