17-01: Challenges in selecting rate vs. rhythm control in Atrial Fibrillation
Notice bibliographique
Résumé
Purpose: Atrial Fibrillation (AF) is a complex disorder with multiple causes and different clinical manifestations, which may challenge physicians in their treatment decisions. In a previous Canadian study, physicians reported difficulties in the selection of rate versus rhythm control in the management of AF, and provided heterogeneous answers to case-based treatment strategy questions. A study was designed to investigate the challenges reported by European Cardiologists, Neurologists, and General Practitioners/Family Physicians in the diagnosis, treatment and management of AF. Methods: This mixed methods ethics-approved study included exploratory semi-structured qualitative interviews (designed to generate in-depth discussion around challenges in diagnosing, treating and managing AF), followed by a quantitative survey including clinical cases (designed to validate the findings from the interviews). Cardiologists, Neurologists, and General Practitioners/Family Physicians (GPs/FPs) were recruited from France, Germany, Italy, Poland, Spain and the UK. Results: A total of 561 physicians participated in this study (294 cardiologists, 131 neurologists, and 136 GPs/FPs). The response rate was 7%. Thirty-six percent (36%) of the sample had an AF patient caseload making up more than 20% of their total patient caseload and 90% of the sample had over 10 years of clinical practice experience. Eleven challenges were identified in relation to the diagnosis, treatment and management of AF. In particular, when questioned about specific detailed clinical cases of patients with AF, participants reported being uncertain when making treatment decisions in relation to rate control vs. rhythm control strategies. When choosing rhythm control, the decisions on how to restore rhythm (cardioversion first vs. anti-arrhythmic drug first) and when to do so (within first 24 hours or later) varied significantly between countries. When selecting a rate control strategy, 84% of cardiologists selected Beta-blockers as the first treatment option, vs. 63% of GPs/FPs. In addition, 61 % of cardiologists reported needing improvement in their skills to select patients who would benefit from AV node ablation (98% Neurologists, 87% GPs/FPs). Significant differences across countries were observed. Conclusions: The findings from this study corroborate the Canadian findings and indicate variability in the skills and treatment decision preferences of physicians involved in the care of AF patients. Differences between countries may indicate variation in implementation of guidelines and/or in access to treatment options. These findings call for targeted educational interventions to improve and standardise the care provided to AF patients by specialists and GPs/FPs alike. These initiatives would benefit from being adapted to local situations, given the variation observed between countries.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».