Abstract
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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-015-0009-1) contains supplementary material, which is available to authorized users.
Highlights
Atrial fibrillation (AF) is commonly managed by a variety of specialists
The increasing pervasiveness of AF has been accompanied by increased emergency department (ED) visits [3,4], hospitalizations, and rising healthcare costs
Recruitment and setting All faculty members in the Academic Hospitalist Program, the Division of Cardiovascular Medicine, and Department of Emergency Medicine at a single tertiary academic teaching hospital were invited to participate in an online survey in February 2012 via an email containing a link to the web-based questionnaire
Summary
Current guidelines differ in their recommendations leading to uncertainty regarding important clinical decisions. Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice, affecting an estimated 5 million adults in the US in 2000 [1] with its prevalence predicted to more than double by 2050 [1,2]. Current consensus guidelines established by the American College of Cardiology (ACC), American Heart Association (AHA), American College of Chest Physicians (ACCP), and European Society of Cardiology (ESC) vary in their recommendations and are ambiguous in regards to management in the acute setting [6,7], largely because high quality studies comparing different management strategies are lacking. Variation regarding management decisions such as selecting rate vs rhythm control, timing and need for thromboembolic treatment, as well as cardiology consultation and indications for hospitalization all result in disparate care of patients
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