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Survey of the attitudes of British physicians to pacing
A W Nathan1, V E Paul, K Judge
1St Bartholomew's Hospital, London.
Insights
Physicians often prioritize patient symptoms over prognostic indicators when deciding on permanent pacemaker implantation. This conservative approach means fewer patients receive pacemakers even when indicated for long-term health.
Area of Science:
- Cardiology
- Medical Practice
Background:
- Published guidelines exist for permanent pacemaker indications.
- Physician opinions on pacing indications and referral practices require assessment.
Purpose of the Study:
- To compare cardiologist, physician, and general practitioner opinions on permanent pacing indications with established guidelines.
- To investigate the influence of resources, experience, and position on pacemaker referral practices.
Main Methods:
- Anonymous postal survey distributed to cardiologists, general physicians, and general practitioners.
- Questionnaire assessed respondent's position, resources, and pacing experience.
- Eleven clinical scenarios were presented to evaluate pacing indications against 1984 American College of Cardiology/American Heart Association guidelines.
Main Results:
- Symptomatic patients were more frequently referred for pacing than asymptomatic patients, irrespective of the cause.
- Pacing recommendations were infrequent for asymptomatic patients, even when prognostically indicated.
- Physician experience with pacing correlated positively with recommending it; facilities and referral access did not significantly influence decisions.
Conclusions:
- Physicians exhibited a conservative approach to recommending permanent pacing.
- Symptom presentation was the primary driver for pacing decisions, overshadowing prognostic indications.
- Prognostic benefits of permanent pacing were not widely recognized among surveyed physicians.
Objectives:
To assess how the opinions of cardiologists, physicians, and general practitioners on the indications for permanent pacing compare with published guidelines, and to determine whether resources, pacing experience, and position influence referral practices.
Design:
Anonymous postal survey by questionnaire from St Bartholomew's Hospital, London and the King's Fund Institute, London. The questionnaire established the respondent's position, resources, and previous pacing experience. Eleven clinical and electrocardiographic situations were described and respondents were asked to decide on whether pacing was indicated. The responses received were compared with the guidelines provided by the 1984 American College of Cardiology/American Heart Association task force.
Participants:
The 630 members of the British Cardiac Society, 1370 randomly selected general physicians, and 2000 general practitioners.
Results:
Patients with symptoms were more likely to be referred for pacing than symptom free patients regardless of underlying aetiology. In relatively symptom free patients the frequency with which pacing was recommended was low, even when it was unequivocally indicated on prognostic grounds. Failure to recommend pacing was unrelated to diagnostic facilities or referral difficulties. Respondents with pacing experience were more likely to recommend pacing.
Conclusions:
The physicians surveyed had a conservative approach towards recommending pacing. Most physicians were influenced predominantly by symptoms and the prognostic indications for pacing were not well appreciated.