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

BMC Cardiovascular Disorders

Research Article

Keith E Kocher¹  Thomas C Crawford²  James B Froehlich²  Ashley M Funk²  Sara Saberi²  Jeffrey M Rohde³  Brady T West⁴ 

[1] Department of Emergency Medicine, University of Michigan School of Medicine, 2800 Plymouth Rd., NCRC Bldg 16, Room152S, 48105-2800, Ann Arbor, MI, USA;Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan School of Medicine, Ann Arbor, USA;Department of Internal Medicine, Division of General Medicine, University of Michigan School of Medicine, 3119 Taubman Center, 1500 E. Medical Center Dr, 48109-5376, Ann Arbor, MI, USA;Survey Research Center, Institute for Social Research, University of Michigan, 426 Thompson Street, Room 4050, 48104-1248, Ann Arbor, MI, USA;

关键词: Atrial Fibrillation;    Dabigatran;    Rivaroxaban;    Apixaban;    Paroxysmal Atrial Fibrillation;   

DOI  :  10.1186/s12872-015-0009-1

 received in 2014-11-13, accepted in 2015-02-18,  发布年份 2015

来源: Springer

【 摘 要 】

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.

【 授权许可】

Unknown   
© Funk et al.; licensee BioMed Central. 2015. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.