Physician stated atrial fibrillation management in light of treatment guidelines: data from an international, observational prospective survey.

Abstract

BACKGROUND:

The Registry on Cardiac Rhythm Disorders Assessing the Control of Atrial Fibrillation (RecordAF) study is the first worldwide, prospective, survey of real-life management of atrial fibrillation (AF) in recently diagnosed patients (n = 5604) with a 1-year follow-up.

HYPOTHESIS:

Surveys of AF management have identified a divergence between guidelines and clinical practice, and an overinterpretation of guidelines in low-risk patients.

METHODS:

: Physicians' theoretical approaches to rhythm and rate control were investigated using a pre-study questionnaire.

RESULTS:

One cardiologist, from each of the 583 sites in 6 regions, completed a questionnaire on their practice and management of AF patients. In AF patients with structural heart disease (SHD), amiodarone was the most frequent choice of first-line rhythm control agents in all regions. Amiodarone or sotalol tended to be the preferred second-line rhythm control agents, 1 exception being Central/South America. beta-Blockers were the first-line rate control agents for patients with AF and SHD in all regions, and calcium channel blockers and cardiac glycosides were the most common second-line rate control treatments in all regions, except Asia. In lone AF patients, propafenone (30.6%), flecainide (24.1%), and amiodarone (21.7%) were the most common global choices of first-line rhythm control, and amiodarone or sotalol were the preferred second-line rhythm control agents, 1 exception being Central/South America.

CONCLUSIONS:

These results highlight points of divergence from the American College of Cardiology (ACC)/ American Heart Association (AHA)/European Society of Cardiology (ESC) guidelines for the management of AF in terms of first-line drug selection in patients with associated SHD or coronary artery disease.

• Authors: Peter R Kowey, Günter Breithardt, John Camm, Harry Crijns, Paul Dorian, Jean-Yves Le Heuzey, Laurence Pedrazzini, Eric N Prystowsky, Geneviève Salette, Peter J Schwartz, Christian Torp-Pedersen, William Weintraub
• Journal: Clinical cardiology (Clin Cardiol) Vol. 33 Issue 3 Pg. 172-8 (Mar 2010) ISSN: 1932-8737 [Electronic] United States
• PMID: 20235224 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright (c) 2010 Wiley Periodicals, Inc.

Chemical References

• Adrenergic beta-Antagonists
• Anti-Arrhythmia Agents
• Calcium Channel Blockers
• Cardiac Glycosides
• Cardiotonic Agents
• Propafenone
• Sotalol
• Flecainide
• Amiodarone

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Amiodarone (therapeutic use)
• Anti-Arrhythmia Agents (therapeutic use)
• Atrial Fibrillation (drug therapy)
• Calcium Channel Blockers (therapeutic use)
• Cardiac Glycosides (therapeutic use)
• Cardiotonic Agents (therapeutic use)
• Clinical Competence
• Female
• Flecainide (therapeutic use)
• Health Care Surveys
• Health Knowledge, Attitudes, Practice
• Heart Rate (drug effects)
• Humans
• Internationality
• Male
• Middle Aged
• Practice Guidelines as Topic
• Propafenone (therapeutic use)
• Prospective Studies
• Registries
• Sotalol (therapeutic use)
• Surveys and Questionnaires