Physician variation in anticoagulating patients with atrial fibrillation. Dartmouth Primary Care COOP Project
- 1 January 1990
- journal article
- research article
- Published by American Medical Association (AMA) in Archives of Internal Medicine
- Vol. 150 (1), 83-86
- https://doi.org/10.1001/archinte.150.1.83
Abstract
We investigated variations in the oral anticoagulant treatment of atrial fibrillation by physicians in three specialties:family physicians (or general practitioners), general internists, and cardiologists. Results showed general agreement in the anticoagulation decision regarding patients with either mitral valve disease or a history of chronic alcohol abuse, but substantial disagreement in other categories of patients. Estimations of the risk of embolization and risk of hemorrhage differed widely among all physicians, cardiologists generally rating the embolization risks lower than the other physicians. A physician''s treatment decision was strongly related to the relative risk of embolism vs hemorrhage derived for each case. A relationship between physician specialty and treatment decision was also demonstrated, with cardiologists least likely, and family practitioners most likely, to institute anticoagulation in nonrheumatic patients with atrial fibrillation. The reason for this variation appears to be differences in the estimated risk of systemic embolism.This publication has 3 references indexed in Scilit:
- DIAGNOSIS AND TREATMENT OF CORONARY DISEASE: COMPARISON OF DOCTORS' ATTITUDES IN THE USA AND THE UKThe Lancet, 1988
- The Natural History of Lone Atrial FibrillationNew England Journal of Medicine, 1987
- Epidemiologic assessment of chronic atrial fibrillation and risk of strokeNeurology, 1978