AHA.14: Poor communication impedes efforts to curb atrial fibrillation-related stroke

Communication among patients, providers and caregivers about risks for stroke in patients with atrial fibrillation needs an assist. Research presented Nov. 17 at the American Heart Association scientific sessions in Chicago found that when polled, few atrial fibrillation patients understood their stroke risks and some physicians missed opportunities to educate them.

“Many patients were unaware of the connection between atrial fibrillation and stroke entirely,” David Frankel, MD, of the Hospital of University of Pennsylvania in Philadelphia told Cardiovascular Business. Frankel and colleagues from the Heart Rhythm Society, National Stroke Association and Boehringer Ingelheim interviewed 500 physicians, 500 patients with atrial fibrillation, and 200 caregivers of patients with atrial fibrillation and subsequent stroke. Half of the patients interviewed had experienced a stroke.

Two-thirds of patients, they found, had been unaware that atrial fibrillation-related strokes were twice as fatal as non-atrial fibrillation-related strokes. Less than a third of patients knew that atrial fibrillation-related strokes were worse in women. Patients also did not understand the burden that would be placed on family members should they have a stroke.

Ninety percent of physicians believed their patients did not understand the impact an atrial fibrillation-related stroke would have on their lives. Physicians also noted that they themselves found treating patients with oral anticoagulants risky or difficult, noting concerns about bleeding and maintenance.

Around a third of physicians believed that patients were a major barrier to prescribing anticoagulants. However, 93 percent of patients were quoted as being willing to be adherent, especially if it reduced their risk of stroke. It was one example, Frankel noted, of the gaps in perspective between patients and providers.

When Frankel and colleagues asked patients, providers and caregivers about who initiated conversations about atrial fibrillation and stroke risks, most physicians said they were the ones who initiated the conversation, while patients said it was about even between themselves and physicians. Caregivers said 77 percent of the time the conversation was started by the physician. “The point is that physicians and patients are leaving the exam room with different perspectives on the conversation.”

With the numbers of patients who have atrial fibrillation growing, risk for an atrial fibrillation-related stroke is also expanding.

One finding Frankel found surprising was the impact on caregivers. More than half felt socially isolated, had changed relationships with their loved ones following the stroke or had major financial concerns. A third gave up their jobs to care for their loved ones.

Frankel stated that for the barriers to be overcome, communication needs to improve. For that, “We’ve developed a list of recommendations for each stakeholder. We want patients to learn about the risk of stroke with atrial fibrillation and how to reduce that risk.” Frankel and colleagues recommended caregivers attend medical visits with atrial fibrillation patients and ask questions about reducing risks.

Not all recommendations were for patients. “We recommend physicians know and comply with treatment recommendations from their professional societies and understand that patients are highly motivated to reduce their risk of stroke.” He also noted that patients generally complied with prescribed treatment. “We recommend physicians establish infrastructure for managing anticoagulation,” such as anticoagulation clinics, Frankel noted.

All three stakeholders, they found, wanted better quality reading material on atrial fibrillation and stroke. While these exist on professional society websites, Frankel noted that, “physicians need to be aware of the resource.”

Frankel stated that improvement was possible when education, public awareness and awareness of other stakeholders’ perspectives were made clear. The plan is to “drill into the mind of the public the connection between atrial fibrillation and stroke.”