Skip Navigation

European Heart Journal 2001 22(20):1954-1959; doi:10.1053/euhj.2000.2300
Copyright © 2001 by the European Society of Cardiology.
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (27)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Frykman, V.
Right arrow Articles by Rosenqvist, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Frykman, V.
Right arrow Articles by Rosenqvist, M.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Management of atrial fibrillation: discrepancy between guideline recommendations and actual practice exposes patients to risk for complications

V. Frykmana,f1, B. Beermanb, L. Rydéna and M. Rosenqvista

a Department of Cardiology, Karolinska Hospital, Stockholm, Sweden
b Medical Products Agency, Uppsala, Sweden

Received May 15, 2000; accepted May 24, 2000

Abstract

Aims To assess compliance to guidelines in the management of patients with atrial fibrillation.

Methods and Results A total of 728 questionnaires were mailed to physicians with the intention of studying ‘theoretical’ compliance to practice guidelines. A retrospective evaluation of 200 records from consecutive patients hospitalized with atrial fibrillation was performed in order to verify ‘actual’ compliance to guidelines. The response rate to the questionnaires was 68%. More than 94% of the physicians stated that patients with risk factors for thromboembolic complications and chronic atrial fibrillation should receive long-term warfarin treatment. Of evaluated records, 108 patients were in chronic atrial fibrillation with at least one risk factor for stroke, and with no known contraindication to warfarin. In this group, only 40% received warfarin. Moreover, several other discrepancies were detected as regards the use of antiarrhythmic therapy.

Conclusion This study reveals a clear discrepancy between recommendations in guidelines and actual practice in patients with atrial fibrillation. The most important finding was a significant under use of thromboembolic prophylaxis in patients at high risk for such events. Implementation and the study of adherence to management guidelines on atrial fibrillation need to be carefully reviewed by surveys of actual clinical practice in order to establish reasonable therapeutic quality.

Key Words: Atrial fibrillation, guidelines, anticoagulation, antiarrhythmic treatment.

f1 Correspondence: Viveka Frykman, MD, Department of Cardiology, Karolinska Hospital, 171 76 Stockholm, Sweden.

References

  1. Sudlow M, Thomson R, Thwaites B, Rodgers H, Kenny RA. Prevalence of atrial fibrillation and eligibility for anticoagulation in the community. Lancet. 1998;352:1167–1171[CrossRef][ISI][Medline]
  2. Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death. The Framingham heart study. Circulation. 1998;98:946–952[Abstract/Free Full Text]
  3. Kannel WB, Abbott RD, Savage DD, McNamara PM. Epidemiologic features of chronic atrial fibrillation: The Framingham study. N Engl J Med. 1982;306:1018–1022[Abstract]
  4. Laupacis A, Albers G, Dalen J, Dunn M, Feinberg W, Jacobsen A. Antithrombotic therapy in atrial fibrillation. Chest. 1995;108:352–9S
  5. Chang HJ, Bell JR, Deroo DB, Kirk JW, Wasson JH. Physician variation in anticoagulating patients with atrial fibrillation. Arch Intern Med. 1990;150:83–86[Abstract]
  6. Bath PMW, Prasad A, Brown MM, MacGregor GA. Survey of use of anticoagulation in patients with atrial fibrillation. Br Med J. 1993;307:1045[ISI][Medline]
  7. Schlicht JR, Davis RC, Naqi K, Cooper W, Rao V. Physician practices regarding anticoagulation and cardioversion of atrial fibrillation. Arch Intern Med. 1996;156:290–294[Abstract]
  8. Stafford RS, Singer DE. National patterns of warfarin use in atrial fibrillation. Arch Intern Med. 1996;156:2537–2541[Abstract]
  9. Lawson F, McAlister F, Ackman M, Ikuta R, Montague T. The utilization of antithrombotic prophylaxis for atrial fibrillation in a geriatric rehabilitation hospital. J Am Geriatr Soc. 1996;44:708–711[ISI][Medline]
  10. Lip GYH, Beevers DG, Coope JR. Atrial fibrillation in general and hospital practice. Br Med J. 1995;312:175–177[ISI]
  11. Lip GYH, Zarifis J, Watson RDS, Beevers DG. Physician variation in the management of patients with atrial fibrillation. Heart. 1996;75:200–205[Abstract/Free Full Text]
  12. Brodsky MA, Chun JG, Podrid PJ, Douban S, Allen BJ, Cygan R. Regional attitudes of generalists, specialists, and subspecialists about management of atrial fibrillation. Arch Intern Med. 1996;156:2553–2562[Abstract]
  13. Sudlow M, Rodgers H, Kenny RA, Thomson R. Population based study of use of anticoagulation among patients with atrial fibrillation in the community. Br Med J. 1997;314:1529–1530[Free Full Text]
  14. Albers GW, Yim JM, Belew KM. Status of antithrombotic therapy for patients with atrial fibrillation in university hospitals. Arch Intern Med. 1996;156:2311–2316[Abstract]
  15. Lip GYH, Tean KN, Dunn FG. Treatment of atrial fibrillation in a district general hospital. Br Heart J. 1994;71:92–95[Abstract/Free Full Text]
  16. Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993;342:1317–1322[CrossRef][ISI][Medline]
  17. Thomson R, McElroy H, Sudlow M. Guidelines on anticoagulation treatment in atrial fibrillation in Great Britain: variation in content and implications for treatment. Br Med J. 1998;316:509–513[Abstract/Free Full Text]
  18. Gustafsson C, Asplund K, Britton M, Norrving B, Olsson B, Marke LA. Cost effectiveness of primary stroke prevention in atrial fibrillation: Swedish national perspective. Br Med J. 1992;305:1457–1460[ISI][Medline]
  19. Eur Heart J. 1993;10:1427–1433
  20. Lévy S, Breithardt G, Campbell RWF. Atrial fibrillation: Current knowledge and recommendations for management. Eur Heart J. 1998;19:1294–1320[Abstract/Free Full Text]
  21. Arch Intern Med. 1994;154:1449–1457[Abstract]
  22. Lemery R, Brugada P, Cheriex E, Wellens HJJ. Reversibility of tachycardia-induced dysfunction after closed chest ablation of the atrioventricular junction for intractable atrial fibrillation. Am J Cardiol. 1987;60:1406–1408[CrossRef][ISI][Medline]
  23. Grogan M, Smith HC, Gersh BJ, Wood DL. Left ventricular dysfunction due to atrial fibrillation in patients initially believed to have idiopathic dilated cardiomyopathy. Am J Cardiol. 1992;69:1570–1573[CrossRef][ISI][Medline]
  24. Clémenty J, Dulhoste M, Laiter C, Denjoy I, Dos Santos P. Flecainide acetate in the prevention of paroxysmal atrial fibrillation: a nine-month follow-up of more than 500 patient. Am J Cardiol. 1992;70:44A–49A[CrossRef][Medline]
  25. Cobbe SM, Rae AP, Polioniecki JD. A randomized placebo-controlled trial in the prevention of paroxysmal supraventricular tachycardia and atrial fibrillation. Circulation. 1995;92:2550–2557
  26. Prystowsky EN, Benson DW Jr, Fuster V. Management of patients with atrial fibrillation. A statement for health care professionals from the subcommittee on ECG and electrophysiology. American Heart Association. Circulation. 1996;93:1262–1277[Free Full Text]
  27. David D, Segni ED, Klein HO, Kaplinsky E. Inefficacy of digitalis in the control of heart rate in patients with chronic atrial fibrillation: Beneficial effects of an added beta adrenergic blocking agent. Am J Cardiol. 1979;44:1378–1382[CrossRef][ISI][Medline]
  28. Petersen P, Boysen G, Godtfredsen J, Andersen ED, Andersen B. Placebo-controlled, randomized trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation. Lancet. 1989;1:175–179[ISI][Medline]
  29. Circulation. 1991;84:527–539[Abstract/Free Full Text]
  30. Lundström T, Rydén L. Haemorrhagic and thromboembolic complications in patients with atrial fibrillation on anticoagulant prophylaxis. J Intern Med. 1989;225:137–142[ISI][Medline]
  31. Rydén L, Simoons ML. The European Society of Cardiology into the next decade. Eur Heart J. 2000;21:1193–1201[Free Full Text]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 EuropaceHome page
A. Meiltz, M. Zimmermann, P. Urban, A. Bloch, and on behalf of the Association of Cardiologists of t
Atrial fibrillation management by practice cardiologists: a prospective survey on the adherence to guidelines in the real world
Europace, June 1, 2008; 10(6): 674 - 680.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
D. A. Lane and G. Y.H. Lip
Barriers to Anticoagulation in Patients With Atrial Fibrillation: Changing Physician-Related Factors
Stroke, January 1, 2008; 39(1): 7 - 9.
[Full Text] [PDF]

Home page
 EuropaceHome page
Writing Committee Members, V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, et al.
ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: 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) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society
Europace, September 1, 2006; 8(9): 651 - 745.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al.
ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: 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) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society
J. Am. Coll. Cardiol., August 15, 2006; 48(4): e149 - e246.
[Full Text] [PDF]

Home page
 CirculationHome page
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al.
ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: 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): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society
Circulation, August 15, 2006; 114(7): e257 - e354.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
L. Friberg, N. Hammar, M. Ringh, H. Pettersson, and M. Rosenqvist
Stroke prophylaxis in atrial fibrillation: who gets it and who does not?: Report from the Stockholm Cohort-study on Atrial Fibrillation (SCAF-study)
Eur. Heart J., August 2, 2006; 27(16): 1954 - 1964.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
R. Nieuwlaat, A. Capucci, A. J. Camm, S. B. Olsson, D. Andresen, D. W. Davies, S. Cobbe, G. Breithardt, J.-Y. Le Heuzey, M. H. Prins, et al.
Atrial fibrillation management: a prospective survey in ESC Member Countries: The Euro Heart Survey on Atrial Fibrillation
Eur. Heart J., November 2, 2005; 26(22): 2422 - 2434.
[Abstract] [Full Text] [PDF]

Home page
 Arch Intern MedHome page
B. J. Dixon, Y. Bracha, S. W. Loecke, M. A. Guerrero, R. D. Taylor, and R. W. Asinger
Principal Atrial Fibrillation Discharges by the New ACC/AHA/ESC Classification
Arch Intern Med, September 12, 2005; 165(16): 1877 - 1881.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart J SupplHome page
S. Schulman and R. J. Beyth
Risk of bleeding with long-term antithrombotic therapy in atrial fibrillation
Eur. Heart J. Suppl., May 1, 2005; 7(suppl_C): C34 - C40.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart J SupplHome page
P. S.J. Miller, M. F. Drummond, L. K. Langkilde, J. J.V. McMurray, and M. Ogren
Economic factors associated with antithrombotic treatments for stroke prevention in patients with atrial fibrillation
Eur. Heart J. Suppl., May 1, 2005; 7(suppl_C): C41 - C54.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
SPORTIF Executive Steering Committee for the SPORT
Ximelagatran vs Warfarin for Stroke Prevention in Patients With Nonvalvular Atrial Fibrillation: A Randomized Trial
JAMA, February 9, 2005; 293(6): 690 - 698.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (27)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Frykman, V.
Right arrow Articles by Rosenqvist, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Frykman, V.
Right arrow Articles by Rosenqvist, M.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?