Impact of the type of centre on management of AF patients: surprising evidence for differences in antithrombotic therapy decisions.
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Impact of the type of centre on management of AF patients: surprising evidence for differences in antithrombotic therapy decisions. / Kirchhof, P; Nabauer, M; Gerth, A; Limbourg, T; Lewalter, T; Goette, A; Wegscheider, Karl; Treszl, András; Meinertz, Thomas; Oeff, M; Ravens, U; Breithardt, G; Steinbeck, G; Investigators, AFNET Registry.
in: THROMB HAEMOSTASIS, Jahrgang 105, Nr. 6, 6, 2011, S. 1010-1023.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Impact of the type of centre on management of AF patients: surprising evidence for differences in antithrombotic therapy decisions.
AU - Kirchhof, P
AU - Nabauer, M
AU - Gerth, A
AU - Limbourg, T
AU - Lewalter, T
AU - Goette, A
AU - Wegscheider, Karl
AU - Treszl, András
AU - Meinertz, Thomas
AU - Oeff, M
AU - Ravens, U
AU - Breithardt, G
AU - Steinbeck, G
AU - Investigators, AFNET Registry
PY - 2011
Y1 - 2011
N2 - 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
AB - 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
KW - Germany
KW - Humans
KW - Registries
KW - Disease Progression
KW - Physician's Practice Patterns
KW - Recurrence
KW - Fibrinolytic Agents/therapeutic use
KW - Ambulatory Care/statistics & numerical data
KW - Hospitals
KW - Atrial Fibrillation/epidemiology/physiopathology/therapy
KW - Cardiology
KW - Education, Medical, Graduate
KW - General Practitioners
KW - Health Services Accessibility/standards
KW - Professional Practice/statistics & numerical data
KW - Germany
KW - Humans
KW - Registries
KW - Disease Progression
KW - Physician's Practice Patterns
KW - Recurrence
KW - Fibrinolytic Agents/therapeutic use
KW - Ambulatory Care/statistics & numerical data
KW - Hospitals
KW - Atrial Fibrillation/epidemiology/physiopathology/therapy
KW - Cardiology
KW - Education, Medical, Graduate
KW - General Practitioners
KW - Health Services Accessibility/standards
KW - Professional Practice/statistics & numerical data
M3 - SCORING: Journal article
VL - 105
SP - 1010
EP - 1023
JO - THROMB HAEMOSTASIS
JF - THROMB HAEMOSTASIS
SN - 0340-6245
IS - 6
M1 - 6
ER -
