Anticoagulation in atrial fibrillation. Is there a gap in care for ambulatory patients?

Objective. Atrial fibrillation (AF) substantially increases risk of stroke. Evidence suggests that anticoagulation to reduce risk is underused (a "care gap"). Our objectives were to clarify measures of this gap in care by including data from family physicians and to determine why eligible patients were not receiving anticoagulation therapy. Design. Telephone survey of family physicians regarding specific patients in their practices. Setting. Nova Scotia. Participants. Ambulatory AF patients not taking warfarin who had risk factors that made anticoagulation appropriate. Main outcome measures. Proportion of patients removed from the care gap; reasons given for not giving the remainder anticoagulants. Results. Half the patients thought to be in the care gap had previously unknown contraindications to anticoagulation, lacked a clear indication for anticoagulation, or were taking warfarin. Patients' refusal and anticipated problems with compliance and monitoring were among the reasons for not giving patients anticoagulants. Conclusion. Adding data from primary care physicians significantly narrowed the care gap. Attention should focus on the remaining reasons for not giving eligible patients anticoagulants.