Abstract
Background:
The Registry on Cardiac Rhythm Disorders Assessing the Control of Atrial Fibrillation (RecordAF) study is the first worldwide, prospective, survey of real‐life management of atrial fibrillation (AF) in recently diagnosed patients (n = 5604) with a 1‐year follow‐up.
Hypothesis:
Surveys of AF management have identified a divergence between guidelines and clinical practice, and an overinterpretation of guidelines in low‐risk patients.
Methods:
Physicians' theoretical approaches to rhythm and rate control were investigated using a pre‐study questionnaire.
Results:
One cardiologist, from each of the 583 sites in 6 regions, completed a questionnaire on their practice and management of AF patients. In AF patients with structural heart disease (SHD), amiodarone was the most frequent choice of first‐line rhythm control agents in all regions. Amiodarone or sotalol tended to be the preferred second‐line rhythm control agents, 1 exception being Central/South America. β‐Blockers were the first‐line rate control agents for patients with AF and SHD in all regions, and calcium channel blockers and cardiac glycosides were the most common second‐line rate control treatments in all regions, except Asia. In lone AF patients, propafenone (30.6%), flecainide (24.1%), and amiodarone (21.7%) were the most common global choices of first‐line rhythm control, and amiodarone or sotalol were the preferred second‐line rhythm control agents, 1 exception being Central/South America.
Conclusions:
These results highlight points of divergence from the American College of Cardiology (ACC)/ American Heart Association (AHA)/European Society of Cardiology (ESC) guidelines for the management of AF in terms of first‐line drug selection in patients with associated SHD or coronary artery disease. Copyright © 2010 Wiley Periodicals, Inc.
Full Text
The Full Text of this article is available as a PDF (1.5 MB).
References
- 1. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991; 22(8): 983–988. [DOI] [PubMed] [Google Scholar]
- 2. Krahn AD, Manfreda J, Tate RB, et al. The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow‐Up Study. Am J Med 1995; 98: 476–484. [DOI] [PubMed] [Google Scholar]
- 3. Benjamin EJ, Wolf PA, D'Agostino RB, et al. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 1998; 98: 946–952. [DOI] [PubMed] [Google Scholar]
- 4. Stewart S, Hart CL, Hole DJ, et al. A population‐based study of the long‐term risks associated with atrial fibrillation: 20‐year follow‐up of the Renfrew/Paisley study. Am J Med 2002; 113: 359–364. [DOI] [PubMed] [Google Scholar]
- 5. Fuster V, Ryden LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation‐executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation). Eur Heart J 2006; 27: 1979–2030. [DOI] [PubMed] [Google Scholar]
- 6. Nieuwlaat R, Capucci A, Camm AJ, et al. Atrial fibrillation management: a prospective survey in ESC member countries: the Euro Heart Survey on Atrial Fibrillation. Eur Heart J 2005; 26: 2422–2434. [DOI] [PubMed] [Google Scholar]
- 7. Meiltz A, Zimmermann M, Urban P, et al. Atrial fibrillation management by practice cardiologists: a prospective survey on the adherence to guidelines in the real world. Europace 2008; 10: 674–680. [DOI] [PubMed] [Google Scholar]
- 8. Le Heuzey J‐Y, Breithardt G, Camm J, et al. The RecordAF Study: Design, baseline data, and profile of patients according to chosen treatment strategy for atrial fibrillation. Am J Cardiol 2009 [Online]: 10 Dec; doi:10.1016/j.amjcard.2009.10.012. [DOI] [PubMed] [Google Scholar]