Variation in practice patterns among specialties in the acute management of atrial fibrillationReport as inadecuate

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BMC Cardiovascular Disorders

, 15:21

Non-coronary artery cardiac disease


BackgroundAtrial fibrillation AF is commonly managed by a variety of specialists. Current guidelines differ in their recommendations leading to uncertainty regarding important clinical decisions. We sought to document practice pattern variation among cardiologists, emergency physicians EP and hospitalists at a single academic, tertiary-care center.

MethodsA survey was created containing seven clinical scenarios of patients presenting with AF. We analyzed respondent choices regarding rate vs rhythm control, thromboembolic treatment and hospitalization strategies. Finally, we contrasted our findings with a comparable Australasian survey to provide an international reference.

ResultsThere was a 78% response rate 124 of 158, 37% hospitalists, 31.5% cardiologists, and 31.5% EP. Most respondents chose rate over rhythm control 92.2%; 95% CI, 89.1% - 94.5% and thromboembolic treatment 67.8%; 95% CI, 63.8% - 71.7%. Compared to both hospitalists and EPs, cardiologists were more likely to choose thromboembolic treatment for new and paroxysmal AF adjusted OR 2.38; 95% CI, 1.05 - 5.41. They were less likely to favor hospital admission across all types of AF adjusted OR 0.36; 95% CI, 0.17 - 0.79 but thought cardiology consultation was more important adjusted OR 1.88, 95% CI, 0.97 - 3.64. Australasian physicians were more aggressive with rhythm control for paroxysmal AF with low CHADS2 score compared to US physicians.

ConclusionsSignificant variation exists among specialties in the management of acute AF, likely reflecting a lack of high quality research to direct the provider. Future studies may help to standardize practice leading to decreased rates of hospitalization and overall cost.

AbbreviationsAFAtrial fibrillation

EPsEmergency physicians

EDEmergency department

ACCAmerican college of cardiology

AHAAmerican heart association

ACCPAmerican college of chest physicians

ESCEuropean society of cardiology

DCCVDirect current cardioversion

TEETransesophageal echo

Electronic supplementary materialThe online version of this article doi:10.1186-s12872-015-0009-1 contains supplementary material, which is available to authorized users.

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Author: Ashley M Funk - Keith E Kocher - Jeffrey M Rohde - Brady T West - Thomas C Crawford - James B Froehlich - Sara Saberi


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