title: HRS/NSA 2014 Survey of Atrial Fibrillation and Stroke: Gaps in Knowledge and Perspective, Opportunities for Improvement.
abstract: BACKGROUND
  The prevalence of atrial fibrillation (AF) is substantial and increasing. Stroke is common in AF and can have devastating consequences. Oral anticoagulants are effective in reducing stroke risk, but are underutilized.
  
  
  OBJECTIVE
  We sought to characterize the impact of stroke on AF patients and their caregivers, gaps in knowledge and perspective between physicians and patients, and barriers to effective communication and optimal anticoagulation use.
  
  
  METHODS
  A survey was administered to AF patients with and without history of stroke, caregivers of stroke survivors, and physicians across the range of specialties caring for AF and stroke patients.
  
  
  RESULTS
  While AF patients (n = 499) had limited knowledge about stroke, they expressed great desire to learn more and take action to reduce their risk. They were often dissatisfied with the education they had received and desired high-quality written materials. Stroke survivors (n = 251) had poor functional outcomes and often underestimated the burden of caring for them. Caregivers (n = 203) also wished they had received more information about reducing stroke risk before their survivor's event. They commonly felt overwhelmed and socially isolated. Physicians (n = 504) did not prescribe anticoagulants as frequently as recommended by guidelines. Concerns about monitoring anticoagulation and patient compliance were commonly reported barriers. Physicians may underestimate patient willingness to take anticoagulants.
  
  
  CONCLUSIONS
  We identified significant knowledge gaps among patients, caregivers, and physicians in relation to AF and stroke. Furthermore, gaps in perspective often lead to suboptimal communication and decision making. Increased education and better communication between all stakeholders are needed to reduce the impact of stroke in AF.
authors.affiliation: Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: david.frankel@uphs.upenn.edu.
authors.forename: David S
authors.initials: DS
authors.lastname: Frankel
authors.affiliation: Illinois Neurological Institute, OSF Saint Francis Medical Center, Peoria, Illinois.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Parker
authors.affiliation: Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Lynda E
authors.initials: LE
authors.lastname: Rosenfeld
authors.affiliation: Mercy Health Hauenstein Neurosciences, Grand Rapids, Michigan; Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, Grand Rapids, Michigan.
authors.forename: Philip B
authors.initials: PB
authors.lastname: Gorelick
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000628:therapy*; D006306:Health Surveys; D006801:Humans; D019359:Knowledge; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D018570:Risk Assessment; D020521:Stroke / Q000453:epidemiology* / Q000628:therapy*
chemical_list: D000925:Anticoagulants
keywords: Atrial fibrillation; anticoagulation; stroke