OBJECTIVES

To better understand challenges pertaining to care transitions, oral anticoagulant (OAC) treatment and management of non-valvular atrial fibrillation (NVAF) from the viewpoints of physicians and patients.

METHODS

Two surveys were conducted: one targeting 400 physicians who manage NVAF patients and the second targeting 400 NVAF patients. Physicians (cardiologists [C’s] and primary care physicians [P’s]) who treated NVAF patients were identified from medical claims in the HealthCore Integrated Research Database submitted between 3/1/14–3/31/16. Patients were identified from medical claims submitted between 4/1/15–3/31/16. Physician surveys assessed OAC treatment decision approaches and referral management strategies while patient surveys classified respondents according to self-reported OAC use and assessed perceptions around NVAF diagnosis, treatment and setting.

RESULTS :

Of 426 physicians (137 C’s; 289 P’s), 57% were in practice >20 years. C’s and P’s differed in OAC treatment philosophies and perceptions of management strategies: 84% C’s and 62% P’s assessed stroke risk prior to recommending OACs; 54% C’s reported co-managing patients with P’s vs 89% P’s reporting co-management with C’s. Of 398 NVAF patients, 25 never used OACs, 49 were prior only users and 324 were current users. Current OAC nonusers (never and prior usersn=74) differed from current users (n=324) in terms of AF diagnosis setting; 46% of current nonusers vs 31% of current users reported diagnosis in an emergency room. Among OAC never users, 40% reported treatment was never discussed.

CONCLUSIONS :

C‘s and P’s had perceived differences related to co-management of NVAF patients. High rates of NVAF diagnosis in acute care settings could result in gaps in transitions of care, particularly related communication about disease state and medication management. Further, the lack of discussions about NVAF treatments between physicians and patients may impact treatment initiation. Opportunities exist to target quality improvement interventions in NVAF patient co-management and transitions of care.