Atrial fibrillation (AF), the most common arrhythmia encountered in clinical practice, is managed by a variety of specialists. Current guidelines differ in their recommendations and may not adequately address management in the acute setting, leading to uncertainty regarding important clinical decisions. We sought to document practice pattern variation among cardiologists, emergency medicine physicians (EMs), and hospitalists in their management of acute AF at a single academic, tertiary‐care center.
An online survey was created containing 7 clinical scenarios of patients presenting with AF to the emergency department. Each scenario detailed type of AF (new onset, paroxysmal, or permanent), duration of presenting symptoms, and CHADS2 score. Respondent demographic characteristics and choices regarding (1) rate versus rhythm control, (2) anticoagulation, and (3) hospitalization and consultation strategies were studied with univariable and multivariable logistic regression analyses.
There was a 78% response rate (124 of 158), of whom 31.5% were cardiologists, 31.5% EMs, and 37% hospitalists. Most respondents chose rate over rhythm control strategies (92.2%; 95% CI, 89.1%– 4.5%), anticoagulation (67.8%; 95% CI, 63.8%–71.7%), and hospitalization (74.6%; 95% CI, 71.5%–77.7%). In multivariable modeling, there were no significant differences among specialties in choosing rate over rhythm control. However, cardiologists were more likely to choose anticoagulation 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) than EMs or hospitalists in the management of acute presentations of AF.
Practice variation exists among specialties regarding anticoagulation and need for hospital admission and consultation decision making regarding AF presentations in the acute setting. Further studies regarding management of acute presentations of AF may be beneficial to better direct commonly made decisions, helping to standardize practice in the acute setting.
To cite this abstract:Maire A, Kocher K, Rohde J, Crawford T, Froehlich J, Saberi S. Variation in Practice Patterns Among Physicians in the Acute Management of Atrial Fibrillation. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 122. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/variation-in-practice-patterns-among-physicians-in-the-acute-management-of-atrial-fibrillation/. Accessed November 21, 2019.