Guidelines on anticoagulant treatment in atrial fibrillation in Great Britain: variation in content and implications for treatment.
OBJECTIVE
To describe the content of guidelines on the use of anticoagulant treatment in patients with atrial fibrillation and the impact of variations in guidelines on treatment.


METHODS
Postal survey of guidelines, semistructured interview with lead developers of guidelines, and application of guidelines to patient sample.


METHODS
15 lead developers of the 20 guidelines identified in the postal survey were interviewed. 100 patients over 65 with atrial fibrillation to whom the guidelines were applied.


METHODS
Evaluation of guidelines and the methods of dissemination, implementation, review, and evaluation; proportion of patients recommended for anticoagulant treatment by each guideline; and level of agreement between guidelines.


RESULTS
There was considerable variation in whether anticoagulant treatment was recommended for subjects (range 13% to 100%, kappa = 0.12). Guidelines varied greatly in advice on treatment by age, the use of echocardiography, and the target value or range of the international normalised ratio (8 of the 20 guidelines included values unlikely to be effective). Development was unsystematic; evidence based approaches were rarely used, 9 of the 15 lead developers had developed the guidelines themselves, and the 6 guidelines developed by groups relied on informal consensus. Methods to support effective dissemination, implementation, and evaluation were limited.


CONCLUSIONS
The widespread non-systematic production of guidelines has led to considerable variation with implications for the quality of care and clinical decision making. There is a need for a central, well funded programme of guideline development to ensure that valid guidelines are produced and disseminated.
Thomson
R
R
Department of Epidemiology and Public Health, School of Health Sciences, University of Newcastle upon Tyne. Richard.Thomson@newcastle.ac.uk
McElroy
H
H
Sudlow
M
M
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D003657:Decision Making; D004452:Echocardiography; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards; D006113:United Kingdom
D000925:Anticoagulants