title: Anticoagulation in atrial fibrillation. Is there a gap in care for ambulatory patients?
abstract: OBJECTIVE
  Atrial fibrillation (AF) substantially increases risk of stroke. Evidence suggests that anticoagulation to reduce risk is underused (a "care gap"). Our objectives were to clarify measures of this gap in care by including data from family physicians and to determine why eligible patients were not receiving anticoagulation therapy.
  
  
  METHODS
  Telephone survey of family physicians regarding specific patients in their practices.
  
  
  METHODS
  Nova Scotia.
  
  
  METHODS
  Ambulatory AF patients not taking warfarin who had risk factors that made anticoagulation appropriate.
  
  
  METHODS
  Proportion of patients removed from the care gap; reasons given for not giving the remainder anticoagulants.
  
  
  RESULTS
  Half the patients thought to be in the care gap had previously unknown contraindications to anticoagulation, lacked a clear indication for anticoagulation, or were taking warfarin. Patients' refusal and anticipated problems with compliance and monitoring were among the reasons for not giving patients anticoagulants.
  
  
  CONCLUSIONS
  Adding data from primary care physicians significantly narrowed the care gap. Attention should focus on the remaining reasons for not giving eligible patients anticoagulants.
authors.affiliation: Dalhousie University, Department of Family Medicine, Dalhousie University, Halifax, NS. Wayne.Putnam@Dal.ca
authors.forename: Wayne
authors.initials: W
authors.lastname: Putnam
authors.forename: Kelly
authors.initials: K
authors.lastname: Nicol
authors.forename: David
authors.initials: D
authors.lastname: Anderson
authors.forename: Brenda
authors.initials: B
authors.lastname: Brownell
authors.forename: Meredith
authors.initials: M
authors.lastname: Chiasson
authors.forename: Frederick I
authors.initials: FI
authors.lastname: Burge
authors.forename: Gordon
authors.initials: G
authors.lastname: Flowerdew
authors.forename: Jafna
authors.initials: J
authors.lastname: Cox
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D000075202:Contraindications; D004363:Drug Utilization; D005194:Family Practice; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009674:Nova Scotia; D010349:Patient Compliance; D010818:Practice Patterns, Physicians'; D020521:Stroke / Q000150:complications / Q000517:prevention & control; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin