Arrhythmia

Why thromboprophylaxis guidance doesn’t translate into practice for Australian AF patients


Overwhelmingly complex guidelines and lack of timely access to a cardiologist are some of the reasons why Australian patients with AF are not receiving recommended oral anticoagulant treatment.

A WA study involving face-to-face interviews with nine GPs identified the decision-making process as one of the sticking points for non-adherence with  thromboprophylaxis guidelines.

Most GPs said they had not read or were not sure they had read the NHFA/CSANZ clinical guidelines for AF. Others would like to see the 58-page document condensed for their reading pleasure.

“Yeah, they’re massive … they’ve laid it all out with all the evidence and intermingled with the actual decision. So it would have been nice to just have a one page of these [that] are the guidelines, and then all the evidence afterwards,” one of the GP participants said.

The study, published in Thrombosis Research, said GPs were also of the opinion that AF was just one of many patient issues requiring active management.

“When it comes to guidelines, they sometimes forget that there are lots of other organ systems,” a participant said.

Another participant said guidelines were not rules that had to be followed.

GPs also acknowledged that balancing the risks and benefits of thromboprophylaxis was a challenge as well as communicating risk to the patient.

“GPs’ lack of familiarity with thromboprophylaxis guidelines appears to have further contributed to them relying on clinical experience rather than the risk stratification tools, or on risk stratification tools that are no longer recommended in contemporary guidelines,” the study said.

GPs were also concerned about getting timely access to cardiologists, particularly in the public system.

“So our worry there is that if you haven’t got them well controlled, and you haven’t got them on the right drug, they’re going to be on this for a few months before they get reviewed by a cardiologist,” one of the participants said.

The investigators said a combination of education and training, comprehensive review of patients’ case notes, and a pharmacist-led intervention and/or an intervention to promote timely prescribing support from cardiologists could aid appropriate thromboprophylaxis decisions in difficult cases.

“Establishing partnerships between general practices and local hospitals may help facilitate access to a cardiologist. This could be complemented with clinical audits of AF patients’ medical records, undertaken by allied health professionals, so that patients not on guideline-adherent thromboprophylaxis could be identified for possible consultation with a cardiologist.”

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