384 Challenges in the management of atrial fibrillation: Results from a national educational needs assessment

Abstract

Atrial fibrillation (AF) is a common form of sustained arrhythmia. However, existing literature indicates that there may be uncertainty surrounding strategies to manage patients with AF. This suggest the presence of gaps, defined as the difference between existing evidence-based best practices (“what should be”) and the actual care being delivered in everyday practice (“what is”). To determine potential gaps in the perceived knowledge, skills and competencies of Canadian physicians caring for patients with AF, a national IRB-approved needs assessment was undertaken. A mixed-method approach was employed in this study. Qualitative data from semi-structured interviews and quantitative data from an online survey were triangulated to assure reliability of findings. The study sample (n = 161) included 43 family physicians and general practitioners, 23 internal medicine specialists, 48 cardiologists, 28 emergency physicians, 14 neurologists, and 5 patients. Gaps and barriers were identified across the continuum of care, including screening, diagnosis, treatment, and management, as well as in the referral process, and in collaboration and communication competencies. Optimal management of AF was impeded by challenges in factoring all comorbidities of a patient in the development of a management plan, as well as in involving the patient in the management plan for his AF. Patients' concerns with regards to side-effects, and patients' resistance to the systematic follow-ups associated with anti-coagulation, were identified as a barrier by 74.8% and 68.4% respectively of the physicians who took part in the quantitative phase. A lack of easily accessible and relevant patient education material was also noted, being identified as a barrier by 71.1% of physicians. Inconsistencies were found in participants' perception of the role of physical activity and diet in the prevention of arrhythmia episodes in AF patients. Finally, inconsistencies in the application of evidence-based practice in the decision to hospitalize or not AF patients were observed. Findings indicate that there are gaps existing across the entire continuum of care, including gaps in the management for AF. Results from this study provide direction for solutions through physician education and professional development.