Objectives: To evaluate the knowledge, attitudes and difficulties of family doctors in the indication of oral anti-coagulation treatment (OCT) in patients with non-valvular auricular fibrillation (NVAF).
Design: Transversal descriptive study.Setting. Area 11 of Madrid primary care.Participants. 250 doctors by simple randomised sampling.
Main measurements: After a pilot study at a health centre, mailing of a questionnaire with a subsequent re-mailing. This collected social and personal details, knowledge of the question, attitudes and difficulties.
Results: 157 (62.8%) replied; 91 were women (58.0%); mean age was 39 (SD, 6.0). 97 had reviewed the question recently (61.8%). 110 thought that the anti-aggregation criteria were clear (70.1%; CI, 62.2-77.0%), 107 that the oral anti-coagulation criteria were (68.2%; CI, 60.2-75.2%), 132 that the OCT risks were (84.1%; CI, 77.2-89.2%), and 74 that risk factors of cerebrovascular accident were clear (47.1%; CI, 39.2-55.2%). Initially 96 doctors gave anti-aggregants and referred to cardiology (61.1%; CI, 53.0-68.7%), and 29 began OCT (18.5%; CI, 12.9-25.6%). 134 thought that we avoided initiating OCT (85.3%; CI, 78.6-90.3%), giving as the main reasons the difficulty of monitoring and of requesting further tests, the risks involved and OCT not being up-to-date.
Conclusions: Most professionals have the criteria for OCT in NVAF clear, although they continue to avoid the initiation of OCT. The majority approach is to give anti-aggregants and refer to Cardiology, given the risk of the therapy and the difficulties involved in monitoring and requesting further tests.
Objetivo: Evaluar los conocimientos, actitudes y dificultades de los médicos de familia para la indicación de tratamiento anticoagulante oral (TAO) en pacientes con fibrilación auricular no valvular (FANV)
Diseño: Estudio descriptivo transversal
Emplazamiento: Área 11 de Atención Primaria de Madrid.
Participantes: Muestra de 250 médicos por muestreo aleatorio simple.
Mediciones principales: Envío de un cuestionario con un reenvío posterior, tras “pilotaje” previo en un centro de salud, que recogía variables sociodemográficas, conocimientos sobre el tema, actitudes y dificultades.
Resultados: Contestaron 157 personas (62,8%), 91 mujeres (58,0%), con una edad media de 39 años (desviación estándar [DE], 6,0). De ellas, 97 han revisado el tema recientemente (61,8%). Creen que están claros los criterios de antiagregación 110 encuestados (70,1%; intervalo de confianza [IC], 62,2–77,0); los de anticoagulación oral 107 (68,2%; IC, 60,2–75,2); los riesgos del TAO 132 (84,1%; IC, 77,2–89,2), y los factores de riesgo de accidente cerebrovascular 74 (47,1%; IC, 39,2–55,2). Inicialmente antiagregan y derivan a cardiología 96 de los encuestados (61,1%; IC, 53,0–68,7) e inician TAO 29 (18,5%; IC, 12,9–25,6). Creen que evitamos iniciar TAO 134 de los encuestados (85,3%; IC, 78,6–90,3), señalando como principales causas la dificultad del seguimiento y para solicitar pruebas complementarias, los riesgos y la falta de actualización
Conclusiones: La mayoría de los profesionales tiene claros los criterios de TAO en la FANV, aunque siguen evitando iniciar TAO, siendo la actitud mayoritaria antiagregar y derivar a cardiología, debido al riesgo de esta terapia y a la dificultad para hacer el seguimiento y solicitar pruebas complementarias.