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

Funk AM, Kocher KE, Rohde JM, West BT, Crawford TC, Froehlich JB, Saberi S - BMC Cardiovasc Disord (2015)

Bottom Line: Australasian physicians were more aggressive with rhythm control for paroxysmal AF with low CHADS2 score compared to US physicians.Significant 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan School of Medicine, Ann Arbor, USA. amaire@med.umich.edu.

ABSTRACT

Background: Atrial 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.

Methods: A 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.

Results: There 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.

Conclusions: Significant 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.

No MeSH data available.


Related in: MedlinePlus

Likelihood to Admit and Need for Cardiology Consultation.a: Likelihood to Admit. Bar graph comparing percentages of likelihood to admit in scenarios of new vs paroxysmal vs chronic AF. There was a significant difference in admitting practices between specialties for paroxysmal AF (p < 0.044). Abbreviation: AF, atrial fibrillation. b: Need for Cardiology Consultation. Bar graph comparing the percentage of each specialty that thought a cardiology consult would be necessary for scenarios of new vs paroxysmal vs chronic AF. There was a significant difference in need for consultation between specialties for new onset AF (p = 0.023). Abbreviation: AF, atrial fibrillation.
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Fig3: Likelihood to Admit and Need for Cardiology Consultation.a: Likelihood to Admit. Bar graph comparing percentages of likelihood to admit in scenarios of new vs paroxysmal vs chronic AF. There was a significant difference in admitting practices between specialties for paroxysmal AF (p < 0.044). Abbreviation: AF, atrial fibrillation. b: Need for Cardiology Consultation. Bar graph comparing the percentage of each specialty that thought a cardiology consult would be necessary for scenarios of new vs paroxysmal vs chronic AF. There was a significant difference in need for consultation between specialties for new onset AF (p = 0.023). Abbreviation: AF, atrial fibrillation.

Mentions: The overwhelming majority of respondents in all specialties agreed that scenarios of new presentations of AF (89.7%) required admission (Figure 3a). Cardiologists were least inclined to admit all types of AF (OR 0.36; 95% CI 0.17 to 0.79) and EPs most often favored admission. Specifically, EPs had 15.2 (95% CI 1.26 to 183.73) fold higher odds of admitting cases of new presentations of AF compared to cardiologists. More frequent exposure to AF was associated with a decreased odds of admitting patients in scenarios of new diagnosis AF (OR 0.08; 95% CI 0.01to 0.65) but did not bear any significance on decisions for admitting other types of AF.Figure 3


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

Funk AM, Kocher KE, Rohde JM, West BT, Crawford TC, Froehlich JB, Saberi S - BMC Cardiovasc Disord (2015)

Likelihood to Admit and Need for Cardiology Consultation.a: Likelihood to Admit. Bar graph comparing percentages of likelihood to admit in scenarios of new vs paroxysmal vs chronic AF. There was a significant difference in admitting practices between specialties for paroxysmal AF (p < 0.044). Abbreviation: AF, atrial fibrillation. b: Need for Cardiology Consultation. Bar graph comparing the percentage of each specialty that thought a cardiology consult would be necessary for scenarios of new vs paroxysmal vs chronic AF. There was a significant difference in need for consultation between specialties for new onset AF (p = 0.023). Abbreviation: AF, atrial fibrillation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4359491&req=5

Fig3: Likelihood to Admit and Need for Cardiology Consultation.a: Likelihood to Admit. Bar graph comparing percentages of likelihood to admit in scenarios of new vs paroxysmal vs chronic AF. There was a significant difference in admitting practices between specialties for paroxysmal AF (p < 0.044). Abbreviation: AF, atrial fibrillation. b: Need for Cardiology Consultation. Bar graph comparing the percentage of each specialty that thought a cardiology consult would be necessary for scenarios of new vs paroxysmal vs chronic AF. There was a significant difference in need for consultation between specialties for new onset AF (p = 0.023). Abbreviation: AF, atrial fibrillation.
Mentions: The overwhelming majority of respondents in all specialties agreed that scenarios of new presentations of AF (89.7%) required admission (Figure 3a). Cardiologists were least inclined to admit all types of AF (OR 0.36; 95% CI 0.17 to 0.79) and EPs most often favored admission. Specifically, EPs had 15.2 (95% CI 1.26 to 183.73) fold higher odds of admitting cases of new presentations of AF compared to cardiologists. More frequent exposure to AF was associated with a decreased odds of admitting patients in scenarios of new diagnosis AF (OR 0.08; 95% CI 0.01to 0.65) but did not bear any significance on decisions for admitting other types of AF.Figure 3

Bottom Line: Australasian physicians were more aggressive with rhythm control for paroxysmal AF with low CHADS2 score compared to US physicians.Significant 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan School of Medicine, Ann Arbor, USA. amaire@med.umich.edu.

ABSTRACT

Background: Atrial 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.

Methods: A 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.

Results: There 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.

Conclusions: Significant 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.

No MeSH data available.


Related in: MedlinePlus