Background: Atrial fibrillation (AF) is commonly managed by a variety of specialists. Current guidelines differ in\ntheir recommendations leading to uncertainty regarding important clinical decisions. We sought to document\npractice pattern variation among cardiologists, emergency physicians (EP) and hospitalists at a single academic,\ntertiary-care center.\nMethods: A survey was created containing seven clinical scenarios of patients presenting with AF. We analyzed\nrespondent choices regarding rate vs rhythm control, thromboembolic treatment and hospitalization strategies.\nFinally, we contrasted our findings with a comparable Australasian survey to provide an international reference.\nResults: There was a 78% response rate (124 of 158), 37% hospitalists, 31.5% cardiologists, and 31.5% EP. Most\nrespondents chose rate over rhythm control (92.2%; 95% CI, 89.1% - 94.5%) and thromboembolic treatment (67.8%;\n95% CI, 63.8% - 71.7%). Compared to both hospitalists and EPs, cardiologists were more likely to choose thromboembolic\ntreatment for new and paroxysmal AF (adjusted OR 2.38; 95% CI, 1.05 - 5.41). They were less likely to favor hospital\nadmission across all types of AF (adjusted OR 0.36; 95% CI, 0.17 - 0.79) but thought cardiology consultation was more\nimportant (adjusted OR 1.88, 95% CI, 0.97 - 3.64). Australasian physicians were more aggressive with rhythm control for\nparoxysmal AF with low CHADS2 score compared to US physicians.\nConclusions: Significant variation exists among specialties in the management of acute AF, likely reflecting a lack of\nhigh quality research to direct the provider. Future studies may help to standardize practice leading to decreased rates\nof hospitalization and overall cost.
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