Ge. Mead et al., Cardioversion for atrial fibrillation: the views of consultant physicians,geriatricians and cardiologists, AGE AGEING, 28(1), 1999, pp. 73-75
Background and aims: atrial fibrillation (AF) increases the risk of stroke
and also has adverse haemodynamic consequences. Cardioversion of AF to sinu
s rhythm may obviate the need for long-term anticoagulation and improve car
diovascular haemodynamics, but is probably underused. We therefore investig
ated the views of hospital consultants about cardioversion for AE
Methods: 336 postal questionnaires were sent to all 186 consultant physicia
ns, 54 cardiologists and 96 geriatricians in Scotland, followed by one remi
nder letter to non-responders.
Results: 71% of questionnaires were returned. Cardiologists referred 18% of
AF patients for cardioversion, while physicians referred 11% and geriatric
ians 5%. Cardiologists had better access to cardioversion facilities and we
re less likely to consider an enlarged left atrium and organic heart diseas
e to be contra-indications to cardioversion. Anticoagulation was given for
less than 3 weeks before cardioversion by 9% of cardiologists, 39% of physi
cians and 65% of geriatricians (P < 0.001), and for less than 3 weeks after
cardioversion by 17% of cardiologists, 45% of physicians and 47% of geriat
ricians (P = 0.7).
Summary: the wide variation in practice both between and within the differe
nt specialties suggests that consensus guidelines based on the best availab
le evidence should be developed.