BMJ 1996;312:51 (6 January)

Letters

Quality of service provision for anticoagulation in atrial fibrillation

Bridges from evidence to practice are fragile

EDITOR,--C M Sudlow and colleagues are right to raise doubts about the applicability of the evidence regarding anticoagulation for atrial fibrillation to current situations in both primary and secondary care.1 This debate takes place, however, in a wider context: there are further barriers to the implementation of research findings that need to be addressed. Clinical situations are complex, and even if all the relevant resources were in place for widespread anticoagulant treatment how likely is it that such treatment would become routine rather than the domain simply of enthusiasts? Three such barriers are as follows.

Firstly, clinicians are concerned that studies select patients too carefuly, thus maximising both the effects of the clinical risk and responsiveness to the intervention.2 This bias may be addressed by selecting and monitoring "real life" patients as carefully as is done in the trials.1 But a second barrier . . . [Full text of this article]


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Relevant Article

How To Do It: Service provision and use of anticoagulants in atrial fibrillation
C M Sudlow, H Rodgers, R A Kenny, and R G Thomson
BMJ 1995 311: 558-560. [Extract] [Full Text]

This article has been cited by other articles:

  • Bungard, T. J., Ghali, W. A., Teo, K. K., McAlister, F. A., Tsuyuki, R. T. (2000). Why Do Patients With Atrial Fibrillation Not Receive Warfarin?. Arch Intern Med 160: 41-46 [Abstract] [Full text]  
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