title: Patient outcomes according to adherence to treatment guidelines for rhythm control of atrial fibrillation.
abstract: BACKGROUND
  Although guidelines for antiarrhythmic drug therapy in atrial fibrillation (AF) were published in 2006, it remains uncertain whether adherence to these guidelines affects patient outcomes.
  
  
  RESULTS
  We retrospectively evaluated the records of 5976 consecutive AF patients who were prescribed at least 1 antiarrhythmic drug between 2006 and 2013. Patients with 1 or more prescribed antiarrhythmic drugs that did not comply with guideline recommendations comprised the non-guideline-directed group (=2920); the remainder constituted the guideline-directed group (=3056). Time to events was assessed using the survival analysis method and adjusted for covariates using Cox regression. Rates of adherence to the guidelines increased significantly with a higher degree of prescriber specialization in arrhythmias (49%, 55%, and 60% for primary care physicians, general cardiologists, and cardiac electrophysiologists, respectively, P=0.001) for the first prescribed antiarrhythmic drug. Compared to the non-guideline-directed group, the guideline-directed group had higher rates of heart failure, but lower baseline CHADS2-VASc scores (P<0.001) and lower rates of coronary artery disease, valvular disease, hypertension, hyperlipidemia, pulmonary disease, and renal insufficiency (P<0.05 for all). During 45 ± 26 months follow-up, the guideline-directed group had a lower risk of AF recurrence (hazard ratio=0.86, 95% CI=0.80 to 0.93), fewer hospital admissions for AF (hazard ratio=0.87, 95% CI=0.79 to 0.97), and fewer procedures for recurrent AF, including electrical cardioversion, pacemaker implantation, and atrioventricular nodal ablation (P<0.01 for all). The mortality and stroke risks were similar between the groups.
  
  
  CONCLUSIONS
  Adherence to published guidelines in the antiarrhythmic management of AF is associated with improved patient outcomes.
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (D.Q., G.L., M.B.A., R.R., M.B.M., D.P., F.K., N.V., E.A., S.K.J., S.S.).
authors.forename: Dingxin
authors.initials: D
authors.lastname: Qin
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (D.Q., G.L., M.B.A., R.R., M.B.M., D.P., F.K., N.V., E.A., S.K.J., S.S.).
authors.forename: George
authors.initials: G
authors.lastname: Leef
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (D.Q., G.L., M.B.A., R.R., M.B.M., D.P., F.K., N.V., E.A., S.K.J., S.S.).
authors.forename: Mian Bilal
authors.initials: MB
authors.lastname: Alam
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (D.Q., G.L., M.B.A., R.R., M.B.M., D.P., F.K., N.V., E.A., S.K.J., S.S.).
authors.forename: Rohit
authors.initials: R
authors.lastname: Rattan
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (D.Q., G.L., M.B.A., R.R., M.B.M., D.P., F.K., N.V., E.A., S.K.J., S.S.).
authors.forename: Mohamad Bilal
authors.initials: MB
authors.lastname: Munir
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (D.Q., G.L., M.B.A., R.R., M.B.M., D.P., F.K., N.V., E.A., S.K.J., S.S.).
authors.forename: Divyang
authors.initials: D
authors.lastname: Patel
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (D.Q., G.L., M.B.A., R.R., M.B.M., D.P., F.K., N.V., E.A., S.K.J., S.S.).
authors.forename: Furqan
authors.initials: F
authors.lastname: Khattak
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (D.Q., G.L., M.B.A., R.R., M.B.M., D.P., F.K., N.V., E.A., S.K.J., S.S.).
authors.forename: Nishit
authors.initials: N
authors.lastname: Vaghasia
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (D.Q., G.L., M.B.A., R.R., M.B.M., D.P., F.K., N.V., E.A., S.K.J., S.S.).
authors.forename: Evan
authors.initials: E
authors.lastname: Adelstein
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (D.Q., G.L., M.B.A., R.R., M.B.M., D.P., F.K., N.V., E.A., S.K.J., S.S.).
authors.forename: Sandeep K
authors.initials: SK
authors.lastname: Jain
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (D.Q., G.L., M.B.A., R.R., M.B.M., D.P., F.K., N.V., E.A., S.K.J., S.S.).
authors.forename: Samir
authors.initials: S
authors.lastname: Saba
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000401:mortality; D002309:Cardiology / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D058007:Physicians, Primary Care / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: antiarrhythmic drugs; atrial fibrillation; guidelines; outcome
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