New Stroke-Prevention Drugs Spur A-Fib Guides


WASHINGTON – The American College of Physicians Foundation* has created pharmaceutical company–sponsored physician and patient education materials aimed at preventing strokes among the estimated 2.6 million Americans with atrial fibrillation.

Providers who manage patients with atrial fibrillation have tended to underestimate the risk of stroke and overestimate the risk of bleeding from anticoagulants, which has contributed the undertreatment of patients who could benefit from anticoagulation therapy, according to Dr. Samuel Z. Goldhaber. The side effects associated with warfarin made it an unappealing choice. But new oral medications, such as dabigatran, are providing more options, said the cardiologist at Harvard University and Brigham and Women’s Hospital in Boston.

The effort, spearheaded by the ACP Foundation's Initiative on Atrial Fibrillation and Stroke Prevention, shores up the role of primary care in atrial fibrillation management at a time when newly approved alternatives to warfarin have dramatically expanded treatment options. "You don’t need to be a specialist to prevent a stroke from atrial fibrillation," said Dr. Goldhaber, a member the initiative’s panel.

The materials are aimed at helping the internal medicine physician, family physician, or nurse practitioner play a role in preventing stroke by looking for atrial fibrillation, and, when appropriate, selecting a treatment agent, which in the future is more likely to be an oral anticoagulant, he said at a Jan. 10 press conference.

Janssen Pharmaceuticals, manufacturer of rivaroxaban, sponsored the development of the concise, one-page clinician work sheet that can be used at the bedside, a patient and caregiver booklet, and three patient videos to help patients understand whether they are candidates for anticoagulation medication.

In addition, the initiative produced a compendium addressing quality of care issues at the hospital level for the purposes of educating staff about atrial fibrillation management.

In evaluating whether patients are candidates for anticoagulation therapy, the clinician tool advises the use the CHADS2scoring system to assess stroke risk, the outpatient bleeding risk index (OBRI), and doing an assessment of the individual’s risk for falling.

The patient booklet, in large print, features tips from atrial fibrillation patients.

The videos feature a physician’s explanation of anticoagulation therapy, including a discussion of treatment options with an actual patient

When patients are more empowered and educated, they are more likely to adhere to any decisions they make with their clinicians, said Dr. Barbara Schuster of Georgia Health Sciences University in Augusta, and cochair of the ACP’s initiative panel.

"It is the conversation between the patient and clinician that helps them take hold of their own health care," she said.

But the tools aren’t only about medication, Dr. Goldhaber noted. As patients review the materials, they will get an overview of stroke risk, which is designed to reinforce the importance of heart-healthy living; maintaining a healthy blood pressure, taking antihypertensive medications, and eating sensibly, he said.

The new materials are expected to be available at the ACP website, and they are scheduled to be presented and distributed at the ACP annual meeting this spring.

Dr. Goldhaber has received research support from Bristol-Myers Squibb, Boehringer Ingelheim, Eisai, EKOS, Johnson & Johnson, and Sanofi-Aventis. He has served as a consultant to Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi, Eisai, Merck, Pfizer, Portola, and Sanofi-Aventis.

* Correction: An earlier version of this story did not accurately identify the role of the ACP Foundation. The error has been corrected.

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