Factors Influencing Physicians' Selection of Dabigatran in Non-valvular Atrial Fibrillation

Purpose: This study was designed to examine the factors that influence physicians’ decision in initiating or switching from warfarin to dabigratran.

Methods: A survey questionnaire was sent to 181 physicians who were most likely to prescribe dabigatran (e.g., cardiologists and general internists) at the University of California, San Francisco (UCSF) Medical Center between November 2011 and February 2012. Survey participants were asked to complete an electronic or a paper version of the questionnaire, which consisted of 17 multiple-choice questions. Fisher’s exact test and Cochran-Mantel-Haenszel test were used to compare survey responses between cardiologists and general internists.

Results: A total of 65 survey responses were received (35.9% response rate). Thirteen cardiologists and 51 general internists participated in the study. Cost (25%), renal function (21%) and CHADS2 score (18%) were the three factors physicians considered most often to determine a patient’s eligibility for dabigatran in warfarin-naïve patients. On the other hand, histories of unstable INR (37%) and missed appointments (17%) along with cost (19%) were most often considered in patients on warfarin. Cardiologists had prescribed dabigatran more often and had a significantly higher level of comfort with prescribing the drug than general internists (p=0.003; 77% vs. 27%).

Conclusion: Cost was the most important factor influencing physicians’ decision to prescribe dabigatran. Safety and effectiveness of dabigatran as well as patient preference were additional factors influencing their decision. General internists may be targeted for education on dabigatran because they were less comfortable with prescribing dabigatran than cardiologists.