Anticoagulation therapy is unique in that it crosses over many medical specialty areas, including cardiology, primary care and internal medicine, emergency physicians, hematologists, neurologists, surgeons, electrophysiologists, clinical pharmacists and nurse practitioners. These professionals interact with patients and their caregivers, with the pharmacies dispensing drugs and information and with the health care systems paying the bills. Overseeing the safety of the drugs are regulatory agencies and drug surveillance systems. If this wasn’t complex enough, many new oral anticoagulants have entered the marketplace in recent years, bringing with them new questions and concerns for both providers and patients alike.

On the provider side, recent focus groups conducted for the ACC and targeting patients and providers outside the cardiology community, found that the majority of providers rank patient bleed risk, cost and patient adherence to treatment as some of the biggest barriers to optimal use of the new anticoagulants. Specifically, providers expressed frustration with the low level of control they believe they have over treatment options, suggesting health insurers rather than physicians are the ultimate decision makers for treatments. There were also concerned about the lack of a reversal agent for the newer anticoagulants. Other provider challenges included a perceived lack of cohesion between cardiologists and primary care physicians on treatment approaches; lack of data on the new anticoagulants, particularly as they compare to each other; and liability concerns.

Lack of knowledge about the new anticoagulants and cost were among the biggest barriers identified by patients in the ACC focus groups. After describing the newer anticoagulants and providing data about these medications, the patients were interested in new treatment options, and had questions about whether or not their insurance would cover them. Several patients also raised safety concerns, saying recent negative television advertising had scared them away from a particular medication.

In an effort to address all of these concerns, the ACC in September hosted an “Anticoagulation Consortium Roundtable” that brought together a diverse group of stakeholders involved in anticoagulation management for robust discussions on topics ranging from management of bleeding and emergency care, to treatment of complex disease states and special patient populations. The goal of the meeting, as expressed best by ACC Vice President Kim Allan Williams, MD, FACC, was to bring together a “consortium of people who can speak as one voice.”

Moving forward, the plan is to publish the proceedings from the Roundtable and use them to help guide the development of additional resources and tools under the umbrella of the College’s Anticoagulation Initiative. Clearly, if the focus groups are a guide, there is real need for both patient and provider education on the risks and benefits associated with the various treatments. Coming out of the Roundtable it’s clear that stakeholder collaboration is necessary if we are to be truly successful in improving patient outcomes and ensuring adherence to guideline-recommended care. The Anticoagulation Initiative hopes to provide the care community with up-to-date, usable tools that address the issues facing the care team. It will be a long road ahead, but we are moving in the right direction.

The Anticoagulation Consortium Roundtable stems from ACC’s Anticoagulation Initiative, a multidisciplinary effort that launched earlier this year. The Initiative’s collection of information and tools helps facilitate a greater understanding of atrial fibrillation treatments and practice patterns.

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Article written by Richard J. Kovacs, MD, FACC. Kovacs is chair of the ACC Anticoagulation Initiative Work Group.

Keywords: Cooperative Behavior, Emergency Medical Services, Physicians, Primary Care, Risk Assessment, Internal Medicine, Insurance, Health, Hemorrhage, Primary Health Care, Cardiology Magazine, ACC Publications

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