REGIONAL ATTITUDES OF GENERALISTS, SPECIALISTS, AND SUBSPECIALISTS ABOUT MANAGEMENT OF ATRIAL-FIBRILLATION

Background: It is unknown whether physicians' attitudes about the mana gement of atrial fibrillation (AF) reflect the recommendations of publ ished guidelines. Methods: To obtain information about physicians' att itudes about management of AF, a questionnaire was returned by 904 (20 .1%) of 4500 physicians involved in managing AF (385 cardiologists, 32 6 internists, and 193 electrophysiologists). The cardiologists and int ernists were from Massachusetts or California; the electrophysiologist s were from around the United States. The questionnaire called for 86 separate answers about use of resources and drug therapy for different types of AF, including recent-onset AF, paroxysmal AF, and chronic AF of less than 6 months' and more than 3 years' duration. Results: Tran sthoracic echocardiography and thyroid function were requested by more than 90% of physicians; transesophageal echocardiography and catheter ization were requested by 10% of physicians. To control ventricular re sponse, digoxin was the overwhelming first-line therapy; calcium chann el blockers were favored over beta-blockers for adjunct therapy. To pr event thromboemboli, warfarin sodium was preferred for chronic AF; war farin or aspirin were equally considered for paroxysmal AF. In conside ring sinus rhythm, respondents agreed about factors determining whethe r to revert, the number of drug trials, and the first-line drug choice (quinidine sulfate) but disagreed about second-line antiarrhythmic dr ugs and whether to hospitalize the patient before initiating drug ther apy. Conclusions: Physicians ranging from primary care providers to su bspecialists agree on issues of AF management such as heart rate contr ol and anticoagulation. Attitudes vary widely about issues such as ant iarrhythmic drugs.