PHYSICIAN ATTITUDES ABOUT ANTICOAGULATION FOR NONVALVULAR ATRIAL-FIBRILLATION IN THE ELDERLY

Background: Our goal was to determine whether patient age affects a ph ysician's reported likelihood of using anticoagulant therapy or the in tensity of anticoagulant therapy for patients with nonvalvular atrial fibrillation. Methods: We surveyed a nationwide sample of 1189 randoml y selected office-based practitioners in three strata: primary care (g eriatrics, internal medicine, family practice, and general practice), cardiology, and neurology. A vignette-based questionnaire was used to measure attitudes and beliefs regarding anticoagulation risks and effe ctiveness, barriers to anticoagulation in clinical practice, and likel ihood of using anticoagulation and target intensity of anticoagulation at three patient ages (55, 65, and 75 years) for four clinical scenar ios (chronic nonvalvular atrial fibrillation with mild left atrial enl argement, intermittent or paroxysmal atrial fibrillation, recent-onset atrial fibrillation, and atrial fibrillation with recent [3 months] e mbolic stroke). Results: The overall response rate was 38%. The mean w ere ''very'' or ''somewhat'' likely to use anticoagulant therapy for a 65-year-old with left atrial enlargement (71%), intermittent or paryo xysmal atrial fibrillation (68%), recent-onset atrial fibrillation (86 %), or embolic stroke (96%). Fewer physicians were likely to use antic oagulant therapy for a 75-year-old with left atrial enlargement (63%), intermittent or paroxysmal atrial fibrillation (56%), recent-onset at rial fibrillation (80%), or embolic stroke (93%). Among physicians equ ally likely to use anticoagulation for 65- and 75-year-old patients, i ntensity of anticoagulant therapy (target international normalized rat io or prothrombin time ratio) was lower (P<.04) for the 75-year-old. C onclusion: Anticoagulant therapy may be less often and less intensivel y used for elderly patients with nonvalvular atrial fibrillation.