Conocimientos, actitudes y habilidades ante el paciente con fibrilación auricular no valvular anticoagulado en atención primaria: análisis cualitativo mediante técnica de grupos focales

Abstract

Backgrounds and objective. Atrial fibrillation (AF), which shows a growing prevalence in the population, is an important risk factor both for the appearance of stroke as well as mortality due to this cause, and whose prevention is based on treatment with oral anticoagulants. Different studies have manifested that a substantial percentage of patients treated with vitamin K antagonists, the anticoagulants used the most, do not achieve adequate levels of anticoagulation, so that the risk of stroke or hemorrhagic adverse effects increases in these patients. Given the fundamental role played by primary care (PC) in the approach to patients with AF, it is aimed to described the current status of anticoagulation in Spain from the perspective of PC using a qualitative approach, as a continuation of a project initiated in 2017. Materials and methods. Based on the review of reference documents and with the collaboration of a scientific advisory committee, a summarized guideline document was written that contemplated recommendations regarding anticoagulation in the patients with non-valvular atrial fibrillation (NVAF). Using a qualitative analysis based on the method of focus groups, attitudes, knowledge and skills were discussed among the participants and the level of agreement was voted on with a battery of items extracted from said document. A total of 13 items were subjected to evaluation by the participants, 7 of them related with general aspects of management and follow-up of the anticoagulated patient and 6 with specific aspects of the individual clinical practice. If the agreement was 90% or less, a second voting was conducted preceded by a debate among the participants, speakers and moderator. Results. Twenty-seven workshops were conducted within the Spanish territory, with a total participation of 495 general practitioners, and only 1 item of approach and follow-up of the anticoagulated patient and 1 items of the usual clinical practice resulted in a repeated disagreement in the round of votings. Conclusions. In general, the attitudes, knowledge and skills of the general practitioners regarding the recommendations on the approach and follow-up of patients with anticoagulated NVAF are adequate and consistent with the clinical practice guidelines, although some limitations are found in some points in the clinical practice.