title: Contemporary approaches to managing atrial fibrillation: A survey of Australian general practitioners.
abstract: BACKGROUND
  Recent attention to the management of atrial fibrillation (AF) and stroke prevention has emphasised the need to support the use of existing pharmacotherapy through available services and resources, in preference to using the new, more expensive, novel oral anticoagulants. In this regard, general practitioners (GPs) are at the core of care.
  
  
  OBJECTIVE
  To survey Australian GPs regarding their approach to managing AF, particularly in relation to stroke prevention therapy, and to identify the range of services to support patient care.
  
  
  METHODS
  A structured questionnaire, comprising quantitative and qualitative responses, was administered to participating GPs within four geographical regions of NSW (metropolitan, regional, rural areas).
  
  
  RESULTS
  Fifty GPs (mean age 53.74±9.94 years) participated. Most (98 per cent) GPs regarded themselves as primarily responsible for the management of AF, only referring patients to specialists when needed. However, only 10 per cent of GPs specialised in "heart/vascular health". Most (76 per cent) GPs offered point-of-care international normalised ratio (INR) testing, with 90 per cent also offering patient support via practice nurses and home visits. Overall, key determinants influencing GPs' initiation of antithrombotic therapy were: "stroke risk"/"CHADS2 score", followed by "patients' adherence/compliance". GPs focused more on medication safety considerations and the day-to-day management of therapy than on the risk of bleeding.
  
  
  CONCLUSIONS
  Australian GPs are actively engaged in managing AF, and appear to be well resourced. Importantly, there is a greater focus on the benefits of therapy during decision-making, rather than on the risks. However, medication safety considerations affecting routine management of therapy remain key concerns, with patients' adherence to therapy a major determinant in decision-making.
authors.affiliation: Graduate School of Health - Pharmacy, University of Technology Sydney, Sydney, NSW, Australia.
authors.forename: Beata
authors.initials: B
authors.lastname: Bajorek
authors.affiliation: Discipline of General Practice, University of Newcastle, Callaghan, NSW, Australia.
authors.forename: Parker
authors.initials: P
authors.lastname: Magin
authors.affiliation: Dept. of Clinical Pharmacology, Royal North Shore Hospital, St Leonards, NSW, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hilmer
authors.affiliation: Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia.
authors.forename: Ines
authors.initials: I
authors.lastname: Krass
keywords: Atrial fibrillation; antiarrhythmic; antithrombotic; general practitioners; pharmacotherapy; stroke prevention