title: Variation in practice patterns among specialties in the acute management of atrial fibrillation.
abstract: BACKGROUND
  Atrial fibrillation (AF) is commonly managed by a variety of specialists. Current guidelines differ in their recommendations leading to uncertainty regarding important clinical decisions. We sought to document practice pattern variation among cardiologists, emergency physicians (EP) and hospitalists at a single academic, tertiary-care center.
  
  
  METHODS
  A survey was created containing seven clinical scenarios of patients presenting with AF. We analyzed respondent choices regarding rate vs rhythm control, thromboembolic treatment and hospitalization strategies. Finally, we contrasted our findings with a comparable Australasian survey to provide an international reference.
  
  
  RESULTS
  There was a 78% response rate (124 of 158), 37% hospitalists, 31.5% cardiologists, and 31.5% EP. Most respondents chose rate over rhythm control (92.2%; 95% CI, 89.1% - 94.5%) and thromboembolic treatment (67.8%; 95% CI, 63.8% - 71.7%). Compared to both hospitalists and EPs, cardiologists were more likely to choose thromboembolic treatment for new and paroxysmal AF (adjusted OR 2.38; 95% CI, 1.05 - 5.41). They were less likely to favor hospital admission across all types of AF (adjusted OR 0.36; 95% CI, 0.17 - 0.79) but thought cardiology consultation was more important (adjusted OR 1.88, 95% CI, 0.97 - 3.64). Australasian physicians were more aggressive with rhythm control for paroxysmal AF with low CHADS2 score compared to US physicians.
  
  
  CONCLUSIONS
  Significant variation exists among specialties in the management of acute AF, likely reflecting a lack of high quality research to direct the provider. Future studies may help to standardize practice leading to decreased rates of hospitalization and overall cost.
authors.affiliation: Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan School of Medicine, Ann Arbor, USA. amaire@med.umich.edu.
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Funk
authors.affiliation: Department of Emergency Medicine, University of Michigan School of Medicine, 2800 Plymouth Rd., NCRC Bldg 16, Room152S, Ann Arbor, MI, 48105-2800, USA. kkocher@med.umich.edu.
authors.forename: Keith E
authors.initials: KE
authors.lastname: Kocher
authors.affiliation: Department of Internal Medicine, Division of General Medicine, University of Michigan School of Medicine, 3119 Taubman Center, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109-5376, USA. jefrohde@med.umich.edu.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Rohde
authors.affiliation: Survey Research Center, Institute for Social Research, University of Michigan, 426 Thompson Street, Room 4050, Ann Arbor, MI, 48104-1248, USA. bwest@umich.edu.
authors.forename: Brady T
authors.initials: BT
authors.lastname: West
authors.affiliation: Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan School of Medicine, Ann Arbor, USA. thomcraw@med.umich.edu.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Crawford
authors.affiliation: Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan School of Medicine, Ann Arbor, USA. jfroehli@umich.edu.
authors.forename: James B
authors.initials: JB
authors.lastname: Froehlich
authors.affiliation: Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan School of Medicine, Ann Arbor, USA. saberis@med.umich.edu.
authors.forename: Sara
authors.initials: S
authors.lastname: Saberi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000628:therapy*; D001315:Australia; D002309:Cardiology; D004554:Electric Countershock; D004635:Emergency Medicine; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D020445:Hospitalists; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D014481:United States
chemical_list: D000889:Anti-Arrhythmia Agents; D005343:Fibrinolytic Agents