title: Antiarrhythmic strategies in patients with atrial fibrillation managed by cardiologists and internists: Antithrombotic Agents in Atrial Fibrillation (ATA-AF) survey.
abstract: OBJECTIVE
  To provide insights on the antiarrhythmic management of atrial fibrillation among patients enrolled in the Antithrombotic Agents in Atrial Fibrillation (ATA-AF) study, and to assess the adherence of the Italian cardiologists and internists to guidelines recommendations.
  
  
  RESULTS
  The ATA-AF study is a multicenter, observational study with prospective data collection on the management and treatment of patients with atrial fibrillation. From March to July 2010, 6910 patients with atrial fibrillation were recruited in 164 Italian Cardiology (Card) and 196 Internal Medicine (IMed) centers. Permanent atrial fibrillation was diagnosed in 50.8%, persistent atrial fibrillation in 24.4%, paroxysmal in 15.5%, and first-detected atrial fibrillation in 9.3% of the patients. Rhythm control (rhyC) strategy was pursued in 27.5% (39.6% Card vs. 12.9% IMed; P < 0.0001) and rate control (raC) in 51.4% (43.7% Card vs. 60.7% IMed; P < 0.0001); in 21.1% the antiarrhythmic strategy was not defined. Patients assigned to rhyC were younger and with less comorbidities than those assigned to raC. Adjusted multivariable analysis showed that atrial fibrillation type, setting of management, age and site of patient discharge were the most important independent predictors of rhyC assignment. The severity of atrial fibrillation-related symptoms was not associated with rhyC assignment. At discharge, beta-blockers, amiodarone and class 1c antiarrhythmic drugs were the drugs mainly used in the Card centers; and beta-blockers, digitalis, amiodarone and diltiazem/verapamil were used in the IMed centers. Amiodarone was overused in both Card and IMed centers.
  
  
  CONCLUSIONS
  In the present study, rhyC was the strategy mainly pursued by cardiologists and raC by internists; treatment strategy assignment and antiarrhythmic therapy often do not agree with the guideline recommendations.
authors: aDepartment of Cardiology, Padre Antero Micone Hospital, Genova-Sestri Ponente bANMCO Research Center, Florence cDepartment of Internal Medicine, Buon Consiglio FBF Hospital, Napoli dDepartment of Internal Medicine, Presidio Ospedaliero, Osimo eDepartment of Cardiology, AORN Cardarelli, Napoli fDepartment of Cardiology, San Gerardo Hospital, Monza gDepartment of Internal Medicine, Pinerolo Hospital, Pinerolo hDepartment of Cardiology, Maggiore Hospital, Bologna, Italy.
authors: Massimo Zoni
authors: MZ
authors: Berisso
authors: Gianna
authors: G
authors: Fabbri
authors: Lucio
authors: L
authors: Gonzini
authors: Davide
authors: D
authors: Caruso
authors: Andrea
authors: A
authors: Fontanella
authors: Francesco
authors: F
authors: Pellegrini
authors: Nunzia
authors: N
authors: Silvestri
authors: Antonio
authors: A
authors: Vincenti
authors: Giovanni
authors: G
authors: Mathieu
authors: Giuseppe
authors: G
authors: Di Pasquale
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D016507:Cardiology Service, Hospital / Q000592:standards; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006760:Hospitalization; D006801:Humans; D007388:Internal Medicine / Q000379:methods / Q000592:standards; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011446:Prospective Studies; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control
chemical_list: D000889:Anti-Arrhythmia Agents; D005343:Fibrinolytic Agents