Abstract 43: A Case-based Survey Of Physician Practice Patterns Following Asymptomatic, Wearable Device-detected Irregular Rhythm

Abstract

Background: While the US FDA has cleared wearable device software for the detection of irregular rhythms suggestive of atrial fibrillation, there is little evidence to guide decision-making in response to abnormal rhythm notifications. We evaluated physician practice patterns across specialties at 2 large academic centers. Methods: We conducted a case-based survey of attending and resident physicians in primary care, emergency medicine, and cardiology at Yale and UCSF from September to December 2021. Case scenarios were presented where patients reported receiving wearable device alerts for “signs of an irregular rhythm suggestive of atrial fibrillation” in the absence of symptoms. Physicians were asked to select from among prespecified diagnostic testing, referral and treatment options, including none. We used a Chi-square test of independence to compare decisions across specialties. Results: We emailed 636 physicians and 95 surveys (14.9%) were completed: 39 primary care, 25 emergency medicine, and 31 cardiology. In response to 192 case scenarios, 99.5% of physicians selected at least one diagnostic test: electrocardiography (96.4%), ambulatory rhythm monitoring (77.1%), transthoracic echocardiography (TTE) (32.8%), stress tests (9.9%), and brain natriuretic peptide (BNP) (8.9%) (Fig A). When asked about referral and treatment options, 18.8% of physicians selected referral to a different specialty and 25.0% selected new medication treatment, including aspirin (18.2%), antiarrhythmics (15.1%), and anticoagulation (9.4%) (Fig B). Emergency physicians were more likely than primary care physicians and cardiologists to refer patients (P=.048) and order a BNP (P=.003). Cardiologists were more likely to perform ambulatory rhythm monitoring (P<.001) and prescribe antiarrhythmics (P=.02). Conclusion: There was considerable variation across physician specialties in practice patterns for asymptomatic, device-detected irregular rhythms.