What Do Afib Patients Know About Stroke?

FEBRUARY 25, 2016
Jeannette Y. Wick, RPh, MBA, FASCP
More than 3 million individuals in the United States have atrial fibrillation, and 1 in 4 Americans will develop the condition during his or her lifetime.

Atrial fibrillation more than quadruples the risk for stroke and increases the prevalence of disabling strokes, but some patients may be unaware of these dangers.

The evidence supporting the role of oral anticoagulants in reducing stroke risk is clear and voluminous. However, clinicians underutilize oral anticoagulants in the atrial fibrillation population.

A study investigating the barriers to anticoagulant use, patient awareness of stroke risk, and the impact of stroke on caregivers appeared in a recent issue of the Journal of Stroke and Cerebrovascular Diseases.

The Heart Rhythm Society and National Stroke Association appointed experts in atrial fibrillation and stroke to create surveys for patients, caregivers, and attending physicians.

They conducted the survey online or by phone between May 27, 2014, and July 3, 2014, and patients, caregivers, and physicians were compensated for their time. The response rates were 12.4%, 14.6%, and 5.2%, respectively.

The survey found that patients underestimated the impact of stroke but were keenly interested in stroke prevention. Patients were largely unaware of the symptoms of a stroke, the differences between strokes, and the elevated stroke risk associated with atrial fibrillation.

General practitioners were more likely than specialists to prescribe antiplatelet agents rather than guideline-recommended anticoagulants. Physicians’ perception about the difficulty of managing vitamin K antagonists and lack of awareness or comfort with the use of novel anticoagulants were identified as barriers to care.

Patients with atrial fibrillation often underestimated the burden of care they created, and this was reflected in caregivers’ responses.

Caregivers expressed feelings of isolation and reported being overwhelmed. They said that in retrospect, they would have liked more information about stroke prevention before the patient they cared for experienced a stroke.

Patients retain information provided in written materials better than messages conveyed verbally, so educational handouts available from the major professional societies could be helpful in promoting more awareness. Education is the most powerful tool to appropriately introduce and continue anticoagulant therapy among atrial fibrillation patients at risk of stroke.

These study findings were limited by recall bias, selection bias (impacted stroke survivors and their caregivers were more likely to answer the survey), and lack of nurse input.