Steven A. Rothman, MD - AFib Treatment: General Population - Figure 7

Underestimating Risk of Stroke

The question as to why oral anticoagulation therapy is so underutilized can be asked 3 times, because there appear to be 3 possible responses.

The first possible reason for the underutilization of anticoagulation therapy is that physicians tend to underestimate the risk of stroke associated with AFib. There are 3 possible explanations for this misconception, as listed in the Figure, that will be discussed in the next few Figures. These may include:

Physicians’ belief that the AFib presentation does not require the patient to undertake long-term anticoagulation therapy (e.g., it is paroxysmal, not persistent, AFib);
Application of a validated AFib treatment strategy (e.g., successful rate or rhythm control) making physicians more comfortable about not also treating the stroke risk of AFib; or
Physicians incorrectly assigning patients to a “low risk” status.

The second possible reason for the underutilization of anticoagulation therapy is that physicians may have misconceptions about the risk of anticoagulation. Finally, a third possible reason is that physicians (and patients) may perceive difficulties about the use of warfarin that also inhibit utilization. These second and third possible reasons will be discussed as answers to questions #2 and #3, below.

Rothman SA. Am J Med 2013; 126: 00-00.