European Heart Journal Advance Access originally published online on April 19, 2007
European Heart Journal 2007 28(9):1172-1173; doi:10.1093/eurheartj/ehm057
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Stroke prophylaxis in patients with atrial fibrillation: what can we do about it?
Senior Lecturer in Pharmacy Practice
Faculty of Education, Health & Science
School of Science (Building 42)
Charles Darwin University
Darwin 0909
Northern Territory
Australia
Tel: +61 8 894 66 563, E-mail address: mark.naunton{at}cdu.edu.au
Friberg et al.1 have shown clearly, like others, that many patients with atrial fibrillation (AF) do not receive stroke prophylaxis. In their summary, they note that it is ‘urgent to increase awareness of the need for adequate stroke prophylaxis in AF patients’. I would like to highlight to the readers that there has been research conducted in Tasmania, Australia on an intervention which aimed to increase warfarin use in those at risk of stroke. Jackson et al.2 mailed guidelines, which were developed in consultation with local specialists, to 272 general practitioners and then approximately 60% of these were visited to discuss the guidelines. Jackson et al. showed that this form of ‘academic detailing’ was effective at increasing warfarin use in the intervention area compared with a control region (P < 0.001), which did not receive the guidelines and academic detailing. Furthermore, hospital admission data (in the intervention area) collected before and after the intervention showed a significant increase in the use of warfarin in patients at high risk of stroke (33 vs. 46% of eligible patients; P < 0.05).
It appears from the study by Friberg et al. that educating cardiologists is not the main priority. Since patients spend most of their time out of hospital it seems logical to me that educating and disseminating guidelines to general practitioners should be of high priority.
References
- Friberg L, Hammar N, Ringh M, Pettersson H, Rosenqvist M. Stroke prophylaxis in atrial fibrillation: who gets it and who does not? Report from the Stockholm Cohort-study on Atrial Fibrillation (SCAF-study). Eur Heart J (2006) 27:1954–1964.
[Abstract/Free Full Text] - Jackson SL, Peterson GM, Vial JH. A community-based educational intervention to improve antithrombotic drug use in atrial fibrillation. Ann Pharmacother (2004) 38:1794–1799.
[Abstract/Free Full Text]
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