Clinical practices and treatment preferences in chronic coronary syndrome management among Indian physicians

Introduction: Chronic coronary syndrome (CCS) is a significant contributor to morbidity and mortality worldwide, particularly in India, where risk factors such as hypertension and diabetes are increasingly prevalent. Effective management of CCS typically involves lifestyle modifications, pharmacotherapy, and sometimes interventional procedures. Methods: A digital questionnaire-based survey was conducted across multiple sites in India, involving cardiologists and consultant physicians. The survey comprised nine questions addressing the prevalence of CCS, preferred treatments, and factors influencing prescribing decisions for novel oral anticoagulants (NOACs). Results: A total of 66 physicians were enrolled. Approximately 40.30% of physicians reported that more than 40% of their patients had CCS. The majority of physicians (57.81%) reported that dual antiplatelet therapy (DAPT) was most preferred treatment for CCS. Around 51% of physicians reported bleeding risk as the primary hindrance in prescribing rivaroxaban and aspirin for CCS patients. The majority of physicians (42.19%) preferred rivaroxaban with a prescription rate of 40%. Apixaban was most commonly prescribed at a rate of 30% by 33.87% of physicians, while dabigatran was typically prescribed at rates of 10% and 20% (41.82% each). Warfarin was prescribed for 10% of patients by 51.79% of respondents. In non-valvular atrial fibrillation cases, 73.13% preferred rivaroxaban primarily for its once-daily dosing advantage. Conclusion: The present study reveals current trends in the management of CCS and the utilization of NOACs among physicians in India. It underscores the growing significance of NOACs, particularly rivaroxaban, in enhancing treatment outcomes for patients with CCS.