Key result
Pill-in-the-pocket strategy remains considered for ~25% of patients, primarily in recent-onset AFib with minimal structural disease.
Why the study?
The pill-in-the-pocket approach is recognized by guidelines for acute conversion of recent-onset AF, but its current real-world utilization had not been systematically evaluated.
How is the pill-in-the-pocket method currently used by clinicians for terminating episodes of atrial fibrillation?
Cross-Sectional
Yes
How is the pill-in-the-pocket method currently used by clinicians for terminating episodes of atrial fibrillation?
The pill-in-the-pocket strategy is frequently considered by clinicians for about a quarter of AF patients, but significant deviations from guideline-appropriate use highlight a need for further physician education.
Supports clinician education on PITP appropriateness; leaves open prospective evaluation of real-world safety and efficacy.
AIMS: Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice. Episodes may stop spontaneously (paroxysmal AF); may terminate only via intervention (persistent AF); or may persist indefinitely (permanent AF) (see European and American guidelines, referenced below, for more precise definitions). Recently, there has been renewed interest in an approach to terminate AF acutely referred to as 'pill-in-the-pocket' (PITP). The PITP is recognized in both the US and European guidelines as an effective option using an oral antiarrhythmic drug for acute conversion of acute/recent-onset AF. However, how PITP is currently used has not been systematically evaluated. METHODS AND RESULTS: The recently published Antiarrhythmic Interventions for Managing Atrial Fibrillation (AIM-AF) survey included questions regarding current PITP usage, stratified by US vs. European countries surveyed, by representative countries within Europe, and by cardiologists vs. electrophysiologists. This manuscript presents the data from this planned sub-study. Our survey revealed that clinicians in both the USA and Europe consider PITP in about a quarter of their patients, mostly for recent-onset AF with minimal or no structural heart disease (guideline appropriate). However, significant deviations exist. See the Graphical abstract for a summary of the data. CONCLUSION: Our findings highlight the frequent use of PITP and the need for further physician education about appropriate and optimal use of this strategy.
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Reiffel et al. (2023) conducted a cross-sectional in Atrial fibrillation. Pill-in-the-pocket (PITP) method was evaluated on Current PITP usage. The pill-in-the-pocket strategy is considered by clinicians in the USA and Europe in about 25% of their patients, mostly for recent-onset atrial fibrillation with minimal structural heart disease.
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