Abstract
To determine how US physicians treat patients with asymptomatic ventricular arrhythmias we conducted in fall 1992, after the publication of all CAST results, a telephone survey of a randomly selected sample of 1072 American generalists (G) and cardiologists (C), as part of a survey designed to study how the results of three major cardiovascular clinical trials have influenced medical practice. 730 physicians reported treating patients with ventricular arrhythmias. The response rate was 63% (G: 65.3%, C: 60.9%). 44.2% of G, but only 22.1% of C would routinely use an antiarrhythmic drug (AAD) or device to treat a patient presenting ventricular premature depolarizations (VPD) who had a myocardial infarction (MI) in the past six months (p < 0.001). 68.2% of G and 40% of C would treat the same patient if he presented asymptomatic nonsustained ventricular tachycardia (NSVT), p < 0.001. For the former condition, the first choice drug would be a tl-blocker (G = 53.5%, C = 74%,p < 0.002). but 28.3% of G and 23.5% of C would use a class IMD (with < 1% using a class IC). 36.9% of G and 16.1% of C would treat a patient with coronary heart disease and an ejection fraction < 40% presenting asymptomatic VPD, 66.2% of Gand 39.6% of Cwould treat asymptomatic NSVT (p < 0.001). For asymptomatic VPD, the first choice drug is a Class IMD (G = 46.4%, C = 47.2%); 27.4% of Gand 44.4% of Cwould prescribe a β-blocker; 11.9% of G but no C would prescribe a calcium-blocker. For the physicians treating NSVT, the first choice drug is:Class IClass IIClass IIIClass IVOtherOtherIAIBICAADG (n = 145)49%0%0.7%1.72%0%9.7%4.8%11.7%C (n = 91)51.7%12.1%1.1%29.7%2.2%2.2%0%1.1%Total50%8.9%0.8%22%0.8%6.8%3%7.6% Many physicians reported use of class IAAD for the treatment of post-MI patients with asymptomatic VPD in spite of the CAST findings. This survey suggests that more effective methods of dissemination of clinical trials results are needed.
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