Nearly 80 Percent of cardiologists say ischemic stroke risk reduction is their primary goal in non-valvular atrial fibrillation treatment, new survey shows

RIDGEFIELD, Conn., March 28, 2014 /PRNewswire/ -- Boehringer Ingelheim Pharmaceuticals, Inc. (BIPI) today announced results from a new survey of cardiologists to understand their perceptions about anticoagulation, stroke risk reduction and goals for non-valvular atrial fibrillation (NVAF) therapy when prescribing warfarin or a novel oral anticoagulant. The online survey, conducted by Harris Poll on behalf of BIPI, included 300 licensed U.S. cardiologists who treat at least five NVAF patients per month.

Cardiologists overwhelmingly responded that reducing the risk of ischemic stroke was their primary treatment goal for patients with NVAF (79 percent). When asked which one of a number of factors has the most impact when determining oral anticoagulation therapy for patients with NVAF, cardiologists said efficacy in reducing risk of ischemic stroke (42 percent), followed by cost to the patient (15 percent), overall safety profile of the medication (14 percent), patient preferences (7 percent), patient medical history (6 percent) and risk of bleeding due to anticoagulant (5 percent). Additionally, 69 percent of cardiologists said that fear of experiencing a clot that leads to a stroke is their patients' top concern with respect to their NVAF treatment.

Despite the strong consensus on the top treatment priority, cardiologists say that nearly half the time (47 percent) they prescribe an oral vitamin K antagonist, an anticoagulant that only 13 percent of respondents believe to be most effective at reducing ischemic stroke risk in patients with NVAF.

"The risk of ischemic stroke is a significant concern for physicians treating patients with NVAF, and a top fear for our patients," said Eric D. Peterson, MD, MPH, Director of the Duke Clinical Research Institute, Duke University Medical Center in Durham, North Carolina. "While many important factors, including safety and cost, must be considered when making treatment decisions, it is important that physicians evaluate all of the data available for the novel oral anticoagulants versus vitamin K antagonists in reducing the risk of ischemic stroke in NVAF."

Survey Also Reveals Real-World Challenges Faced by Cardiologists


Even though nearly four out of five cardiologists (79 percent) believe their NVAF patients with a treatment plan have at least a moderate understanding of the potential severity of an ischemic stroke due to NVAF, almost all (98 percent) believe there are some barriers to reducing ischemic stroke risk. Nearly all cardiologists acknowledge that they usually consider many factors, not just efficacy, when choosing a treatment (96 percent). 

The cardiologists surveyed said the most common barriers to reducing the risk of stroke due to NVAF they experience are patient complaints related to logistical, lifestyle or cost issues associated with medicines that reduce the risk of ischemic stroke (74 percent) and concerns about the risk of bleeding (71 percent). Cardiologists believe their patients are very or extremely concerned about a number of issues related to the medicines they are taking to reduce their risk of ischemic stroke due to NVAF, including cost (77 percent), risk of bleeding (75 percent), side effects (69 percent), the need for regular follow-up appointments for monitoring of anticoagulation (51 percent), and inconvenient dosing (42 percent).

"The good news is that the majority of patients understand the connection between atrial fibrillation and stroke risk. As health care professionals, we must make sure patients understand how anticoagulant treatment can reduce their stroke risk and what anticoagulant is right for them," said Peter R. Kowey, MD, Chief of the Division of Cardiovascular Diseases at Lankenau Hospital Main Line Health System, Philadelphia, Pennsylvania. "Ultimately, good physician-patient communication early on can help overcome barriers to treatment."

Clinical Data: Reducing Ischemic Stroke Risk with Pradaxa® (dabigatran etexilate mesylate) in NVAF

PRADAXA is the only direct thrombin inhibitor approved in the United States for stroke risk reduction in NVAF, and was the first oral anticoagulant (OAC) approved for that indication by the U.S. Food and Drug Administration in more than 50 years. PRADAXA is the only OAC with clinical data demonstrating superiority compared to warfarin in reducing ischemic stroke in patients with NVAF. Nearly nine out of 10 strokes caused by atrial fibrillation are ischemic strokes.

The efficacy and safety of PRADAXA were established in the RE-LY® trial, one of the largest stroke prevention clinical studies ever conducted with NVAF patients. The 18,113-patient RE-LY trial showed that, compared to well-controlled warfarin (N=6,022), PRADAXA 150 mg (N=6,076) significantly reduced the risk of stroke and systemic embolism by 35 percent (primary efficacy endpoint: 134 [2.2%] vs. 202 [3.4%] events, HR: 0.65, 95% CI [0.52, 0.81], P=0.0001), ischemic stroke by 25 percent (103 [1.7%] vs. 134 [2.2%] events, HR: 0.75, 95% CI [0.58, 0.97], P=0.0296) and hemorrhagic stroke by 74 percent (12 [0.2%] vs. 45 [0.8%] events, HR: 0.26, 95% CI [0.14, 0.49],P<0.0001). The rate of all-cause mortality was lower with PRADAXA 150 mg than with warfarin (3.6 percent per year versus 4.1 percent per year). PRADAXA had a higher rate of total GI bleeds (N=681 vs. 452) and major GI bleeds (N=186 vs. 125; 50 percent increased risk with the 150 mg dose compared to warfarin). Treatment with PRADAXA 150 mg led to a 59 percent reduction in intracranial hemorrhage, compared to warfarin (38 vs. 90), and showed numerically lower rates of fatal and life-threatening bleeds (28 vs. 39 and 179 vs. 218, respectively).

About the Survey


The Cardiologists and NVAF Treatment survey was conducted online between January 23 and February 7, 2014 by Harris Poll on behalf of Boehringer Ingelheim among 300 licensed cardiologists who practice in the United States and treat at least five patients with NVAF per month. For the full methodology, including weighting variables, please contact BIPI Public Relations.