Assessment of the Adherence of Cardiologists to Guidelines for the Treatment of Atrial Fibrillation

Abstract

BackgroundNo local studies evaluating the knowledge of cardiologists on the management of atrial fibrillation (AF) and their adherence to these guidelines are available. ObjectiveTo evaluate the knowledge of cardiologists on the guidelines and clinical practices for the treatment of AF, correlating it to the time since medical graduation. MethodsCross-sectional study randomly including cardiologists affiliated to the Society of Cardiology of the State of Rio Grande do Sul (Sociedade de Cardiologia do Estado do Rio Grande do Sul - SOCERGS). The physicians were divided into two groups, according to time since graduation: those graduated for more (G1) or less (G2) than 25 years. ResultsOf the 859 SOCERGS members, 150 were interviewed, and six refused to participate in the study. G1 comprised 71 physicians, and G2, 73. Differences were observed in regard to the following variables: use of betablockers as the first-choice drug for the control of AF response in 59.2% (G1) vs 91.8% (G2) (p<0.0001); use of digoxin as the preferred drug for the control of AF response in 19.7% (G1) vs 0% (G2) (p< 0.0001); warfarin as the preferred anticoagulant in 71.8% (G1) vs 93.2% (G2) (p=0.009); application of a risk score for anticoagulation in 73.2% (G1) vs 87.7% (G2) (p=0.02). In questions regarding the knowledge about the Brazilian Society of Cardiology's guideline for AF, the overall percentage of right answers was 82.3%. ConclusionMost of the clinical measures regarding the management of AF comply with the guidelines, and the clinical practice differs according with the time since graduation.

Stroke Prevention in Atrial Fibrillation: Focus on Latin America

“…65 Furthermore, this survey found that 10% of long practicing cardiologists in Brazil do not adhere to any AF guidelines, while a significant number do not routinely apply risk scores before initiating anticoagulation therapy. 65 A review of prescribing habits in a Brazilian cardiology department found that anticoagulant use according to the Brazilian guidelines was 55%, which was consistent with international guidelines, while 86% of patients with a high risk of embolism were prescribed oral anticoagulants. 66 These statistics suggest that guidelines may not be adhered to strictly in practice, with a significant proportion of Latin American patients not receiving adequate anticoagulation.…”

“…65 Physicians with over 25 years of experience tend to have less awareness of guidelines, or are more likely to disagree with existing guidelines, with only 71.8% favoring VKA as an initial anticoagulant in AF, as recommended in guidelines, compared to over 90% of more junior cardiologists. 65 Furthermore, this survey found that 10% of long practicing cardiologists in Brazil do not adhere to any AF guidelines, while a significant number do not routinely apply risk scores before initiating anticoagulation therapy.…”

“…65 Physicians with over 25 years of experience tend to have less awareness of guidelines, or are more likely to disagree with existing guidelines, with only 71.8% favoring VKA as an initial anticoagulant in AF, as recommended in guidelines, compared to over 90% of more junior cardiologists. 65 Furthermore, this survey found that 10% of long practicing cardiologists in Brazil do not adhere to any AF guidelines, while a significant number do not routinely apply risk scores before initiating anticoagulation therapy. 65 A review of prescribing habits in a Brazilian cardiology department found that anticoagulant use according to the Brazilian guidelines was 55%, which was consistent with international guidelines, while 86% of patients with a high risk of embolism were prescribed oral anticoagulants.…”

Factors In Deciding between Novel and Traditional Oral Anticoagulants to Prevent Embolism in Atrial Fibrillation Patients

“…Undesirable drug interactions and their narrow therapeutic window (borderline between efficacy in embolism prevention and risk of bleeding) are the major limitations of their use and the reason for the need to monitor often the anticoagulation level. 5 - 7 …”

Obesity: A Growing Multifaceted Problem

“…In addition, changes in calcium transport, in collagen and in epicardial fat have been reported as potential mechanisms responsible for obesity-induced cardiac remodeling, associated with myocardial dysfunction 12 , 14 , 15 . It is worth noting that genetic changes, such as ALK7 gene polymorphism, which encodes the TGF-beta receptor, can be related to ventricular remodeling in patients with metabolic syndrome 16 . On the other hand, experimental studies have not identified the participation of the glycolytic pathway 17 or imbalance between phosphorylated and total phospholamban 18 , but have reported a reduction in the expression of type-I collagen in high-fat diet-induced obese rats 19 .…”