Impact of the type of center on management of AF patients: Surprising evidence for differences in antithrombotic therapy decisions

Research output: Contribution to journalArticle

Authors

  • M Nabauer
  • A Gerth
  • T Limbourg
  • T Lewalter
  • A Goette
  • K Wegscheider
  • A Treszl
  • T Meinertz
  • M Oeff
  • U Ravens
  • G Breithardt
  • G Steinbeck

Colleges, School and Institutes

Abstract

Atrial fibrillation (AF) patients may receive treatment from specialists or from general medicine physicians representing different levels of care within a structured health care system. This "choice" is influenced by patient flow within a health care system, patient preference, and individual access to health care resources. We analysed how the postgraduate training and work environment of treating physicians affects management decisions in AF patients. Patient characteristics and treatment decisions were analysed at the time of enrolment into the registry of the German Atrial Fibrillation NETwork (AFNET). A total of 9,577 patients were enrolled from 2004 to 2006 in 191 German centres that belonged to the following four levels of care: 13 tertiary care centres (TCC) enrolled 3,795 patients (39.6%), 58 district hospitals (DH) enrolled 2,339 patients (24.4%), 62 office-based cardiologists (OC) enrolled 2,640 patients (27.6%), and 58 general practitioners or internists (GP) enrolled 803 patients (8.4%). Patients with new-onset AF were often treated in DH. TCC treated younger patients who more often presented with paroxysmal AF. Older patients and patients in permanent AF more often received outpatient care. Consistent with recommendations, younger patients and patients with non-permanent AF received rhythm control therapy more often. In addition, the type of centre affected the decision for rhythm control. Stroke risk was similar between centre types (mean CHADS2 scores 1.6 -1.9). TCC (68.8%) and OC (73.6%) administered adequate antithrombotic therapy more often than DH (55.1%) or GP (52.0%, p

Details

Original languageEnglish
Pages (from-to)1010-1023
Number of pages14
JournalThrombosis and Haemostasis
Volume105
Issue number6
Publication statusPublished - 1 Jan 2011