Management of atrial fibrillation: discrepancy between guideline recommendations and actual practice exposes patients to risk for complications

Aims To assess compliance to guidelines in the management of patients with atrial fibrillation. Methods and Results A total of 728 questionnaires were mailed to physicians with the intention of studying 'theoretical' compliance to practice guidel ines. A retrospective evaluation of 200 records from consecutive patients h ospitalized with atrial fibrillation was performed in order to verify 'actu al' compliance to guidelines. The response rate to the questionnaires was 6 8%, More than 94% of the physicians stated that patients with risk factors for thromboembolic complications and chronic atrial fibrillation should rec eive long-term warfarin treatment. Of evaluated records. 108 patients were in chronic atrial fibrillation with at least one risk factor for stroke. an d with no known contraindication to warfarin. In this group, only 40% recei ved warfarin. Moreover. several other discrepancies were detected as regard s the use of antiarrhythmic therapy. Conclusion This study reveals a clear discrepancy between recommendations i n guidelines and actual practice in patients with atrial fibrillation. The most important finding was a significant under use of thromboembolic prophy laxis in patients at high risk for such events. Implementation and the stud y of adherence to management guidelines on atrial fibrillation need to be c arefully reviewed by surveys of actual clinical practice in order to establ ish reasonable therapeutic quality. (C) 2001 The European Society of Cardio logy.