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.
Conclusion
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.
Key Words
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Article info
Footnotes
The survey administration was supported by Boehringer Ingelheim. Dr Gorelick serves on the speaker's bureau for stroke prevention in atrial fibrillation sponsored by Boehringer Ingelheim and Pfizer.
Abbreviations: AF, atrial fibrillation; TIA, transient ischemic attack.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.06.026
Copyright
© 2015 Heart Rhythm Society and National Stroke Association. Published by Elsevier Inc. All rights reserved.
