Care by an electrophysiology provider was associated with higher use of rhythm control management compared with general cardiology (44.2% vs 29.7%; adjusted OR 1.66, 95% CI 1.05-2.61).
Observational (n=10,097)
Yes
Does provider specialty influence atrial fibrillation treatment strategies in community practice?
In US community practice, electrophysiology providers are significantly more likely to utilize rhythm control strategies for atrial fibrillation compared to general cardiologists and primary care physicians.
Odds Ratio: 1.66 (95% CI 1.05–2.61)
Absolute Event Rate: 44.2% vs 29.7%
p-value: p=<0.0001
BACKGROUND: The prevalence of atrial fibrillation (AF) continues to increase; however, there are limited data describing the division of care among practitioners in the community and whether care differs depending on provider specialty. METHODS AND RESULTS: Using the Outcomes Registry for Better Informed Treatment of AF (ORBIT-AF) Registry, we described patient characteristics and AF management strategies in ambulatory clinic practice settings, including electrophysiology (EP), general cardiology, and primary care. A total of 10 097 patients were included; of these, 1544 (15.3%) were cared for by an EP provider, 6584 (65.2%) by a cardiology provider, and 1969 (19.5%) by an internal medicine/primary care provider. Compared with those patients who were cared for by cardiologists or internal medicine/primary care providers, patients cared for by EP providers were younger (median age, 73 years interquartile range, IQR, 64, 80 years, Q1, Q3 versus 75 years IQR, 67, 82 years for cardiology and versus 76 years IQR, 68, 82 years for primary care). Compared with cardiology and internal medicine/primary care providers, EP providers used rhythm control (versus rate control) management more often (44.2% versus 29.7% and 28.8%, respectively, P<0.0001; adjusted odds ratio OR EP versus cardiology, 1.66 95% confidence interval, CI, 1.05 to 2.61; adjusted OR for internal medicine/primary care versus cardiology, 0.91 95% CI, 0.65 to 1.26). Use of oral anticoagulant therapy was high across all providers, although it was higher for cardiology and EP providers (overall, 76.1%; P=0.02 for difference between groups). CONCLUSIONS: Our data demonstrate important differences between provider specialties, the demographics of the AF patient population treated, and treatment strategies-particularly for rhythm control and anticoagulation therapy.
Fosbøl et al. (2013) conducted an observational in Atrial fibrillation (n=10,097). Electrophysiology (EP) provider care vs. General cardiology provider care was evaluated on Use of rhythm control (versus rate control) management (OR 1.66, 95% CI 1.05 to 2.61, p=<0.0001). Care by an electrophysiology provider was associated with higher use of rhythm control management compared with general cardiology (44.2% vs 29.7%; adjusted OR 1.66, 95% CI 1.05-2.61).