title: Inappropriate use of antiarrhythmic drugs in paroxysmal and persistent atrial fibrillation in a large contemporary international survey: insights from RealiseAF.
abstract: OBJECTIVE
  International atrial fibrillation (AF) guidelines have defined optimal drugs for patients with various underlying diseases, but the extent to which real-life practice complies with these guidelines is unknown. This study aimed to evaluate the appropriate use of antiarrhythmic drugs (AADs) in patients with paroxysmal and persistent AF from the RealiseAF survey, according to the 2006 American College of Cardiology/American Heart Association/European Society of Cardiology AF guidelines.
  
  
  RESULTS
  RealiseAF was an international cross-sectional, observational survey of 10 523 eligible patients from 26 countries on 4 continents, with ≥1 AF episode documented by standard electrocardiogram or by Holter monitoring in the last 12 months. Participating physicians were randomly selected during 2009-10 from lists of office-based or hospital-based cardiologists and internists. Overall, 4947 patients with paroxysmal (n = 2606) or persistent AF (n = 2341) were included; mean (standard deviation) age was 64.7 (12.4) and 66.0 (11.8) years, respectively. Class Ic drugs were prescribed in 589 patients (11.9%); however, in 20.0% of these patients, the indication was not consistent with published guidelines. Similarly, for the 219 patients prescribed sotalol (4.4%), 16.0% received treatment for an indication that deviated from the published guidelines. Amiodarone was prescribed as first-line therapy in 1268 patients (25.6%), but 49.9% of these did not have heart failure or hypertension with significant left ventricular hypertrophy.
  
  
  CONCLUSIONS
  The use of AADs for persistent or paroxysmal AF in this large contemporary international survey showed some deviations from international guidelines. The highest discordance came with the use of amiodarone in first line. Clearly, there is a large discrepancy between published guidelines and current practice.
authors.affiliation: General Clinical Research Center and Division of Cardiology, Taipei Veterans General Hospital, National Yang-Ming University, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan.
authors.forename: Chern-En
authors.initials: CE
authors.lastname: Chiang
authors.forename: Marnix
authors.initials: M
authors.lastname: Goethals
authors.forename: James O
authors.initials: JO
authors.lastname: O'Neill
authors.forename: Lisa
authors.initials: L
authors.lastname: Naditch-Brûlé
authors.forename: Sandrine
authors.initials: S
authors.lastname: Brette
authors.forename: Habib
authors.initials: H
authors.lastname: Gamra
authors.forename: Oleg
authors.initials: O
authors.lastname: Zharinov
authors.forename: P Gabriel
authors.initials: PG
authors.lastname: Steg
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D017723:Drug Utilization Review; D004562:Electrocardiography; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D057970:Inappropriate Prescribing; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Antiarrhythmic drugs; Atrial fibrillation; Guidelines