17-01: Challenges in selecting rate vs. rhythm control in Atrial Fibrillation
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.030 | 0.068 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.005 | 0.005 |
| Scholarly communication | 0.006 | 0.003 |
| Open science | 0.001 | 0.005 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".