{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T08:48:03Z","timestamp":1762505283878,"version":"build-2065373602"},"reference-count":22,"publisher":"BMJ","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Heart"],"published-print":{"date-parts":[[1996,2]]},"abstract":"<jats:p>OBJECTIVE: To investigate variations in the management of patients with atrial fibrillation among consultant physicians. DESIGN: Questionnaire survey. SUBJECTS: Consultant physicians in England, Wales, and Scotland. RESULTS: 214 consultant physicians (88 cardiologists and 126 non-cardiologists) were surveyed between May and July 1994. Most physicians (47.7%) reported that they saw one to five patients with atrial fibrillation weekly. Some 52% of cardiologists and 40% of non-cardiologists considered that the main factor influencing their decision of whether or not to anticoagulate was the clinical history--that is, heart failure, valve disease, or stroke. When encountering a patient admitted acutely with new onset atrial fibrillation, significantly more cardiologists (66% v 52%, chi 2 = 6.89, P = 0.03) would immediately start anticoagulant treatment, most favouring intravenous heparin. Most physicians would also introduce antiarrhythmic treatment or digoxin, but more cardiologists would attempt immediate pharmacological (39% v 18% of non-cardiologists, P &lt; 0.001) or later electrical (86% v 69%, chi 2 = 11.7, P = 0.003) cardioversion to sinus rhythm, while non-cardiologists tended to prefer \"rate control\" with digoxin. Although many physicians would not continue antiarrhythmic treatment post-cardioversion, more cardiologists than non-cardiologists would do so (the commonest choice being class III agents) (31% v 17%, P = 0.04). Fewer non-cardiologists would continue anticoagulant treatment post-cardioversion (27% v 69% of cardiologists, chi 2 = 39.8, P &lt; 0.0001). When treating patients with atrial fibrillation, decisions about anticoagulation were usually related to the perceived relative risk of thromboembolism versus haemorrhage derived for each of six case management scenarios in the questionnaire. There was, however, general agreement between cardiologists and non-cardiologists in the use of antithrombotic treatment in the management of lone atrial fibrillation, paroxysmal atrial fibrillation, and patients with atrial fibrillation and mitral valve disease or thyrotoxicosis. CONCLUSION: There is considerable variation in the management of atrial fibrillation, with more cardiologists than non-cardiologists considering cardioversion to sinus rhythm (and the use of antiarrhythmic and anticoagulant treatment post-cardioversion) and thrombo-prophylaxis with anticoagulation. Guidelines on the management of this common arrhythmia are clearly required.<\/jats:p>","DOI":"10.1136\/hrt.75.2.200","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:46:00Z","timestamp":1190137560000},"page":"200-205","source":"Crossref","is-referenced-by-count":73,"title":["Physician variation in the management of patients with atrial fibrillation."],"prefix":"10.1136","volume":"75","author":[{"given":"G. Y.","family":"Lip","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Zarifis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. D.","family":"Watson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. G.","family":"Beevers","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1996,2,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1136\/hrt.71.1.92","article-title":"Treatment of atrial fibrillation in a district general hospital","volume":"71","author":"Lip, G.Y.H.; Tean, K.N.; Dunn, F.G.","year":"1994","unstructured":"Lip GYH, Tean KN, Dunn FG. Treatment of atrial fibrillation in a district general hospital. Br Heart Jf 1994;71: 92-5.","journal-title":"Br Heart Jf"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1136\/bmj.307.6911.1045","article-title":"Survey of use of anticoagulation in patients with atrial fibrillation","volume":"307","author":"Bath, P.M.W.; Prasad, A.; Brown, M.M.; MacGregor, G.A.","year":"1993","unstructured":"Bath PMW, Prasad A, Brown MM, MacGregor GA. Survey of use of anticoagulation in patients with atrial fibrillation. BMJ 1993;307:1045.","journal-title":"BMJ"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1177\/003693309403900404","article-title":"Antithrombotic therapy prescribed for patients with non-rheumatic atrial fibrillation","volume":"39","author":"Hendry, A.; Campbell, A.M.; Campbell, G.; Macdonald, J.B.; Williams, B.O.","year":"1994","unstructured":"Hendry A, Campbell AM, Campbell G, Macdonald JB, Williams BO. Antithrombotic therapy prescribed for patients with non-rheumatic atrial fibrillation. Scott Med J 1994;39:110-1.","journal-title":"Scott Med J"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1001\/archinte.1990.00390130089012","article-title":"Physician variation in anticoagulating patients with atrial fibrillation","volume":"150","author":"Chang, H.J.; Bell, JR, Deroo; DB, Kirk; JW, Wasson; J.H.","year":"1990","unstructured":"Chang HJ, Bell JR, Deroo DB, Kirk JW, Wasson JH. Physician variation in anticoagulating patients with atrial fibrillation. Arch Intern Med 1990;150:83-6.","journal-title":"Arch Intern Med"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1136\/bmj.305.6867.1445","article-title":"Antithrombotic treatment and atrial fibrillation","volume":"305","author":"Lowe, G.D.O.","year":"1992","unstructured":"Lowe GDO. Antithrombotic treatment and atrial fibrillation. BMJ 1992;305:1445-6.","journal-title":"BMJ"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1001\/archinte.1994.00420130036007","article-title":"Atrial fibrillation investigators. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomised controlled trials","volume":"154","year":"1994","unstructured":"Atrial fibrillation investigators. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomised controlled trials. Arch Intern Med 1994;154:1449-57.","journal-title":"Arch Intern Med"},{"key":"ref_7","first-page":"687","article-title":"Stroke prevention in atrial fibrillation investigators. Warfarin versus aspirin for prevention of thromboembolism in atrial fibrillation: stroke prevention in atrial fibrillation II study","volume":"343","year":"1994","unstructured":"Stroke prevention in atrial fibrillation investigators. Warfarin versus aspirin for prevention of thromboembolism in atrial fibrillation: stroke prevention in atrial fibrillation II study. Lancet 1994;343:687-91.","journal-title":"Lancet"},{"key":"ref_8","first-page":"750","article-title":"Diagnosis and treatment of coronary disease: comparison of doctors'","volume-title":"attitudes in the USA and the UK. Lancet","volume":"i:","author":"Brook, R.H.; Park, R.E.; Winslow, C.M.; Kosecoff, J.B.; Chassin, M.R.; Hampton, JR","year":"1988","unstructured":"Brook RH, Park RE, Winslow CM, Kosecoff JB, Chassin MR, Hampton JR. Diagnosis and treatment of coronary disease: comparison of doctors' attitudes in the USA and the UK. Lancet 1988;i:750-3."},{"key":"ref_9","first-page":"6","article-title":"Stroke prevention in atrial fibrillation investigators. Predictors of thromboembolism in atrial fibrillation: II. Echocardiographic features of patients at risk","volume":"116","year":"1992","unstructured":"Stroke prevention in atrial fibrillation investigators. Predictors of thromboembolism in atrial fibrillation: II. Echocardiographic features of patients at risk. Ann Intern Med 1992;116:6-12."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1161\/01.STR.21.1.4","article-title":"Thromboembolic complications in atrial fibrillation","volume":"21","author":"Petersen, P.","year":"1990","unstructured":"Petersen P. Thromboembolic complications in atrial fibrillation. Stroke 1990;21:4-13.","journal-title":"Stroke"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/0002-9149(90)90111-D","article-title":"Thromboembolic complications of atrial fibrillation and their prevention: a review","volume":"65","author":"Petersen, P.","year":"1990","unstructured":"Petersen P. Thromboembolic complications of atrial fibrillation and their prevention: a review. Am J Cardiol 1990; 65:24-28C.","journal-title":"Am J Cardiol"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1056\/NEJM198204293061709","article-title":"Atrial fibrillation revisited","volume":"306","author":"Selzer, A.","year":"1982","unstructured":"Selzer A. Atrial fibrillation revisited. N Engl _J Med 1982; 306:1044-5.","journal-title":"N Engl _J Med"},{"key":"ref_13","first-page":"289","article-title":"Thrombolysis in the treatment of acute myocardial infarction","volume-title":"Thrombosis in cardiovascular disorders","author":"Sobel, B.E.","year":"1992","unstructured":"Sobel BE. Thrombolysis in the treatment of acute myocardial infarction. In: Fuster V, Verstraete M, ed. Thrombosis in cardiovascular disorders. Philadelphia: WB Saunders, 1992:289-326."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1056\/NEJM198902093200604","article-title":"Comparison of high dose with low-dose subcutaneous heparin to prevent left ventricular mural thrombosis in patients with acute transmural anterior myocardial infarction","volume":"320","author":"Turpie, A.G.G.; Robinson, J.H.; Doule, D.J.","year":"1989","unstructured":"Turpie AGG, Robinson JH, Doule DJ, et al. Comparison of high dose with low-dose subcutaneous heparin to prevent left ventricular mural thrombosis in patients with acute transmural anterior myocardial infarction. N Engl J7 Med 1989;320:352-7.","journal-title":"N Engl J7 Med"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1146\/annurev.me.39.020188.000353","article-title":"Atrial fibrillation: natural history, complications, and management","volume":"39","author":"Alpert, J.S.; Petersen, P.; Godtfredsen, J.","year":"1988","unstructured":"Alpert JS, Petersen P, Godtfredsen J. Atrial fibrillation: natural history, complications, and management. Annu Rev Med 1988;39:41-52.","journal-title":"Annu Rev Med"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/0002-9149(89)90284-1","article-title":"Echocardiographic and clinical predictors for outcome of elective cardioversion of atrial fibrillation","volume":"63","author":"Dittrich, H.C.; Erickson, J.S.; Schneidermen, T.; Blacky, A.R.; Savides, T.; Nicod, P.H.","year":"1989","unstructured":"Dittrich HC, Erickson JS, Schneidermen T, Blacky AR, Savides T, Nicod PH. Echocardiographic and clinical predictors for outcome of elective cardioversion of atrial fibrillation. Am J Cardiol 1989;63: 193-7.","journal-title":"Am J Cardiol"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/0002-8703(90)90079-D","article-title":"Return of atrial mechanical function following electrical cardioversion of atrial arrhythmias","volume":"120","author":"O'Neill, P.G.; Puleo, P.R.; Bolli, R.; Rokey, R.","year":"1990","unstructured":"O'Neill PG, Puleo PR, Bolli R, Rokey R. Return of atrial mechanical function following electrical cardioversion of atrial arrhythmias. Am HeartJ 1990;120:353-9.","journal-title":"Am HeartJ"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1016\/0735-1097(94)90652-1","article-title":"Impaired left atrial mechanical function after cardioversion: relation to the duration of atrial fibrillation","volume":"23","author":"Manning, W.J.; Silverman, D.I.; Katz, S.E.; Riley, M.F.; Come, P.C.; Doherty, R.M.","year":"1994","unstructured":"Manning WJ, Silverman DI, Katz SE, Riley MF, Come PC, Doherty RM, et al. Impaired left atrial mechanical function after cardioversion: relation to the duration of atrial fibrillation. JAm Coll Cardiol 1994;23:1535-40.","journal-title":"JAm Coll Cardiol"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1378\/chest.95.2_Supplement.118S","article-title":"Antithrombotic therapy in atrial fibrillation","volume":"95","author":"Dunn, M.; Alexander, J.; de Silva, R.; Hildner, F.","year":"1989","unstructured":"Dunn M, Alexander J, de Silva R, Hildner F. Antithrombotic therapy in atrial fibrillation. Chest 1989; 95:118-27S.","journal-title":"Chest"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1056\/NEJM198709103171104","article-title":"The natural history of lone atrial fibrillation. A population-based study over three decades","volume":"317","author":"true","year":"1987","unstructured":"Kopecky SL, Gersh BJ, McGoon MD, et al. The natural history of lone atrial fibrillation. A population-based study over three decades. N Engl Jf Med 1987;317: 669-74.","journal-title":"N Engl Jf Med"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3449","DOI":"10.1001\/jama.1985.03360240061035","article-title":"Characteristics and prognosis of lone atrial fibrillation: 30-year follow up in the Framingham study","volume":"254","author":"Brand, F.N.; Abbott, R.D.; Kannel, W.B.; Wolf, P.F.","year":"1985","unstructured":"Brand FN, Abbott RD, Kannel WB, Wolf PF. Characteristics and prognosis of lone atrial fibrillation: 30-year follow up in the Framingham study. JAMA 1985;254:3449-53.","journal-title":"JAMA"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1016\/0140-6736(93)90950-L","article-title":"Atrial fibrillation and anticoagulation: from randomised trials to practice","volume":"341","author":"Caro, J.J.; Groome, P.A.; Flegel, K.M.","year":"1993","unstructured":"Caro JJ, Groome PA, Flegel KM. Atrial fibrillation and anticoagulation: from randomised trials to practice. Lancet 1993;341:1381-4.","journal-title":"Lancet"}],"container-title":["Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/hrt.75.2.200","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T06:04:21Z","timestamp":1760767461000},"score":1,"resource":{"primary":{"URL":"https:\/\/heart.bmj.com\/lookup\/doi\/10.1136\/hrt.75.2.200"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1996,2]]},"references-count":22,"journal-issue":{"issue":"2","published-online":{"date-parts":[[1996,2,1]]},"published-print":{"date-parts":[[1996,2]]}},"alternative-id":["10.1136\/hrt.75.2.200"],"URL":"https:\/\/doi.org\/10.1136\/hrt.75.2.200","relation":{},"ISSN":["1355-6037","1468-201X"],"issn-type":[{"type":"print","value":"1355-6037"},{"type":"electronic","value":"1468-201X"}],"subject":[],"published":{"date-parts":[[1996,2]]}}}