Atrial fibrillation care in internal medicine: a multicenter survey of screening, anticoagulation responses, and clinical support needs

OBJECTIVES: Internal medicine physicians frequently encounter atrial fibrillation (AF) and anticoagulation-related problems before or alongside cardiology input. We described internal medicine residents' and specialists' first-choice method for confirming suspected AF, how often they reported screening for AF in four prespecified risk-enriched patient groups (screening method and interval were not specified), their responses to common anticoagulation scenarios, and their preferences for practical clinical support. METHODS: We conducted a multicenter cross-sectional online survey in nine hospitals in Türkiye. All 549 eligible internal medicine physicians listed on institutional staffing rosters were invited; 327 completed a 34-item questionnaire (response rate 59.6%). Item-level response distributions were the primary outcomes; resident-specialist comparisons were exploratory. RESULTS: Twelve-lead electrocardiography was selected for diagnostic confirmation by 88.4%. Always/often screening was reported by 19.9%-38.8% of respondents across four prespecified risk-enriched groups: patients aged ≥ 65 years, those with heart failure, those with a history of stroke or transient ischemic attack, and those with diabetes or chronic kidney disease. Fewer than half selected the prespecified reference response in five selected scenarios: stable coronary disease (47.7%), the direct oral anticoagulant-unsuitable option of a mechanical prosthetic valve or moderate-to-severe mitral stenosis (46.5%), apixaban dose reduction (38.5%), minor bleeding (37.9%), and an international normalized ratio outside the target range (34.3%). A practical algorithm was considered useful by 94.5%, structured internal medicine-cardiology collaboration by 86.5%, and 75.5% requested further education. CONCLUSIONS: Although most respondents selected electrocardiography for AF confirmation, always/often screening was reported by fewer than 40% in each assessed risk-enriched group, and responses to anticoagulation scenarios varied, including among specialists. These findings support prospective evaluation of a locally adapted, internist-led pathway integrating opportunistic screening prompts, a defined initial assessment, and clear criteria for timely cardiology input.