Differences in management of atrial fibrillation between cardiologists and non-cardiologists in Greece

We aimed to assess trends in the management of atrial fibrillation (AF) at various levels of medical care in Greece and to compare the treatment practices of cardiologists to those of non-cardiologists.

From January to May 2007, 500 questionnaires were mailed to cardiologists, internists and general practitioners, randomly selected from regional medical associations. Questions assessed management practices for paroxysmal, persistent and permanent AF.

A total of 309 physicians (194 cardiologists and 115 non-cardiologists) responded. Cardiologists showed no preference regarding the site of cardioversion of paroxysmal AF, whereas non-cardiologists tend to cardiovert paroxysmal AF in the emergency department. Intravenous amiodarone is the most frequently used antiarrhythmic agent for cardioversion by both groups (63% vs. 71%, p=NS). Cardiologists utilise propafenone or ibutilide more frequently than non-cardiologists (24% vs. 11%, p<0.05 and 10% vs. 2%, p<0.01 respectively), while 12% of non-cardiologists would use digitalis for cardioversion (vs. 0.5% of cardiologists, p<0.001). Cardiologists prescribe commonly, but less frequently than non-cardiologists (42% vs. 59%, p<0.01) an antiarrhythmic drug after the first episode of paroxysmal AF, propafenone being the most popular among cardiologists (66%) and amiodarone (33%) or digitalis (23%) among general practitioners/internists. Beta-blockers are considered as first choice agents for rate control among cardiologists, while non-cardiologists would prescribe mainly digitalis. Antiplatelet agents were suggested by most physicians after cardioversion of the first episode of AF in low-risk patients. Cardiologists prefer aspirin, while non-cardiologists would prescribe clopidogrel as first choice antiplatelet agent. Both groups would recommend anticoagulants in high risk patients; nevertheless, in elderly patients without other risk factors, anticoagulants are more often prescribed by cardiologists (79% vs. 50%, p<0.001).

Important differences exist in the management of AF between cardiologists and general practitioners/internists in Greece. Non-cardiologists overuse digitalis, underuse beta-blockers, prefer clopidogrel to aspirin and are reluctant to prescribe anticoagulants in the elderly.