Variation in practice patterns among specialties in the acute management of atrial fibrillation

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• 作者：Ashley M Funk (1)
  Keith E Kocher (2)
  Jeffrey M Rohde (3)
  Brady T West (4)
  Thomas C Crawford (1)
  James B Froehlich (1)
  Sara Saberi (1)
  
  1. Department of Internal Medicine ; Division of Cardiovascular Medicine ; University of Michigan School of Medicine ; Ann Arbor ; USA
  2. Department of Emergency Medicine ; University of Michigan School of Medicine ; 2800 Plymouth Rd. ; NCRC Bldg 16 ; Room152S ; Ann Arbor ; MI ; 48105-2800 ; USA
  3. Department of Internal Medicine ; Division of General Medicine ; University of Michigan School of Medicine ; 3119 Taubman Center ; 1500 E. Medical Center Dr ; Ann Arbor ; MI ; 48109-5376 ; USA
  4. Survey Research Center ; Institute for Social Research ; University of Michigan ; 426 Thompson Street ; Room 4050 ; Ann Arbor ; MI ; 48104-1248 ; USA
  
• 刊名：BMC Cardiovascular Disorders
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：15
• 期：1
• 全文大小：998 KB
• 参考文献：1. Go, AS, Hylek, EM, Phillips, KA, Chang, Y, Henault, LE, Selby, JV (2001) Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 285: pp. 2370-5 CrossRef
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  3. McDonald, AJ, Pelletier, AJ, Ellinor, PT, Camargo, CA (2008) Increasing US emergency department visit rates and subsequent hospital admissions for atrial fibrillation from 1993 to 2004. Ann Emerg Med 51: pp. 58-65 CrossRef
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  5. Kim, MH, Johnston, SS, Chu, BC, Dalal, MR, Schulman, KL (2011) Estimation of total incremental health care costs in patients with atrial fibrillation in the United States. Circ Cardiovasc Qual Outcomes 4: pp. 313-20 CrossRef
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  7. January, CT, Wann, LS, Alpert, JS, Calkins, H, Cleveland, JC, Cigarroa, JE (2014) 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 64: pp. e1-76 CrossRef
  8. Fuster, V, Ryden, LE, Cannom, DS, Crijns, HJ, Curtis, AB, Ellenbogen, KA (2006) ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation鈥揺xecutive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). J Am Coll Cardiol 48: pp. 854-906 CrossRef
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  21. Scheuermeyer, FX, Innes, G, Pourvali, R, Dewitt, C, Grafstein, E, Heslop, C (2013) Missed opportunities for appropriate anticoagulation among emergency department patients with uncomplicated atrial fibrillation or flutter. Ann Emerg Med 62: pp. 557-65 CrossRef
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• 刊物主题：Cardiology; Cardiac Surgery; Angiology; Blood Transfusion Medicine; Internal Medicine;
• 出版者：BioMed Central
• ISSN：1471-2261

文摘

Background Atrial 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. Methods A 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. Results There 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. Conclusions Significant 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.