Significant variation exists between cardiologists, physicians, and geriatricians in Scotland regarding referral and anticoagulation practices for AF cardioversion, indicating a need for standardized guidelines.
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Specialty differences in AF cardioversion referral and anticoagulation timing persist; leaves open whether standardized protocols reduce variation or affect outcomes.
BACKGROUND AND AIMS: Atrial fibrillation (AF) increases the risk of stroke and also has adverse haemodynamic consequences. Cardioversion of AF to sinus rhythm may obviate the need for long-term anticoagulation and improve cardiovascular haemodynamics, but is probably underused. We therefore investigated the views of hospital consultants about cardioversion for AF. METHODS: 336 Postal questionnaires were sent to all 186 consultant physicians, 54 cardiologists and 96 geriatricians in Scotland, followed by one reminder letter to non-responders. RESULTS: 71% Of questionnaires were returned. Cardiologists referred 18% of AF patients for cardioversion, while physicians referred 11% and geriatricians 5%. Cardiologists had better access to cardioversion facilities and were less likely to consider an enlarged left atrium and organic heart disease to be contra-indications to cardioversion. Anticoagulation was given for less than 3 weeks before cardioversion by 9% of cardiologists, 39% of physicians and 65% of geriatricians (P<0.001), and for less than 3 weeks after cardioversion by 17% of cardiologists, 45% of physicians and 47% of geriatricians (P = 0.7). SUMMARY: The wide variation in practice both between and within the different specialties suggests that consensus guidelines based on the best available evidence should be developed.
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G E Mead (1999) studied this question.
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