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

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

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The Registry on Cardiac Rhythm Disorders Assessing the Control of Atrial Fibrillation (Record AF) 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 andmanagement 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. β-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 patientswith associated SHD or coronary artery disease.

Original languageEnglish
Pages (from-to)172-178
Number of pages7
JournalClinical Cardiology
Volume33
Issue number3
DOIs
Publication statusPublished - Mar 2010

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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