Perceptions and knowledge gaps on CHA₂DS₂-VASc score components: a joint survey of Chinese clinicians and clinical pharmacists

ABSTRACT

Background

The CHA₂DS₂-VASc score is a guideline-recommended stroke risk stratification scheme for patients with atrial fibrillation (AF). Accurately calculating the CHA₂DS₂-VASc score and recognizing the stroke risk in AF patients is the foundation of optimal anticoagulation therapy. This survey aims to obtain a comprehensive understanding of perceptions and knowledge gaps on CHA₂DS₂-VASc scores among Chinese medical professionals for future education programs.

Methods

A cross-sectional survey was conducted among clinicians, including cardiologists, neurologists, emergency physicians (EPs), general practitioners (GPs) and clinical pharmacists (CPs) using a self-administered questionnaire on the Chinese mainland. The survey contained 21 questions in combination with single-choice questions, multiple-choice questions, and an open-ended question, which was distributed online via e-mail or social media.

Results

A total of 562 participants (40.9% cardiologists, 19.2% neurologists, 8.5% EPs, 10.3% GPs, and 21.0% CPs) completed the survey. Most respondents across all specialties reported skills requiring improvements in the CHA₂DS₂-VASc score. In general, cardiologists, neurologists, and CPs had a relatively better understanding than GPs and EPs about the application of CHA₂DS₂-VASc score. Considering ‘H’ and ‘D’ components, more than 90% of respondents chose the correct answer in single-choice questions, whereas the correctness rate declined concerning detailed scoring criteria. Regarding ‘C,’ ‘A₂,’ ‘S₂,’ and ‘V’ components, partly correct answers were commonly observed in most multiple-choice questions. The majority of cardiologists believed themselves to be very familiar or at least familiar with the score and its components, while around 70% of EPs and GPs felt relatively unfamiliar with the CHA₂DS₂-VASc score. Mobile apps, AF guidelines and notebooks/handbooks were popular referencing scoring tools for respondents.

Conclusions

Chinese medical professionals, especially EPs and GPs, revealed a lack of knowledge and insufficient skills for CHA₂DS₂-VASc scores and their components. Improvements in the awareness of the CHA₂DS₂-VASc score and its detailed scoring criteria are urgently needed for Chinese medical professionals. Therefore, education programs concerning the introduction of stroke risk evaluation for AF patients and the development of referencing scoring tools are necessary.

KEYWORDS:

• Atrial fibrillation
• stroke risk
• cha₂ds₂-vasc score
• perception
• knowledge
• survey
• cross-section
• pharmacist

Acknowledgments

The authors acknowledge those clinicians and CPs who provided their valuable comments during the drafting of the survey. We are also grateful to all the medical professionals participated in this survey for their feedbacks.

Declaration of financial/other relationships

The authors have no other financial disclosures or conflicts of interest to report apart from those disclosed. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Transparency statement

Informed consent statement

Each participant gave their informed consent before answering the questionnaire.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This work was supported by the Research Funds of Shanghai Municipal Commission of Health and Family Planning  (20184Y0022), WU JIEPING medical foundation (320.6750.2020-04-30), Cultivation fund of clinical research of Renji Hospital (PY2018-III-06), Clinical Pharmacy Innovation Research Institute of Shanghai Jiao Tong University School of Medicine (CXYJY2019ZD001), and Shanghai ‘Rising Stars of Medical Talent’ Youth Development Program – Youth Medical Talents – Clinical Pharmacist Program (SHWJRS (2019) 072; SHWRS (2020) 087). The contents of the paper and the opinions expressed within are those of the authors, and it was the decision of the authors to submit the manuscript for publication. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.