Robert Wood Johnson University Hospital NJ.
Sanofi Bridgewater NJ.
J Am Heart Assoc. 2021 Mar 16;10(6):e016792. doi: 10.1161/JAHA.120.016792. Epub 2021 Mar 9.
Background Current American Heart Association/American College of Cardiology/Heart Rhythm Society guidelines and European Society of Cardiology guidelines recommend antiarrhythmic drugs (AADs) for maintenance of sinus rhythm in patients with atrial fibrillation. We assessed the concordance between healthcare provider real-world practice and current guidelines with respect to first-line AAD rhythm management. Methods and Results Administrative claims data from the deidentified Optum Clinformatics Data Mart database were used. Patients were included if they were initiated on an AAD in 2015 to 2016, had 1 year of continuous data availability before their first AAD pharmacy claim, and had a diagnosis for atrial fibrillation within that period. Concordance was assessed by comparing the AAD initiated by the healthcare provider against guideline recommendations for first-line treatment, given the presence of heart failure, coronary artery disease, both, or neither (as determined by and [ and ] codes). Concordance was also assessed by provider type using Medicare taxonomy codes. For the 15 445 patients included, 51% of healthcare providers initiated AAD treatments with amiodarone, 18% flecainide, 15% sotalol, 8% dronedarone, 5% propafenone, and 2% dofetilide. The overall rate of guideline concordance was 61%, with differences by provider type: 67% for electrophysiologists, 61% for cardiologists, and 60% for others (internal medicine, etc). Conclusions There continues to be a sizable gap in concordance between practice and guidelines in first-line rhythm management of patients with atrial fibrillation. Further research is needed to identify possible explanations for non-guideline-recommended use of AADs, in addition to enhanced AAD educational strategies for practitioners.
背景 当前，美国心脏协会/美国心脏病学会/心律学会指南和欧洲心脏病学会指南均建议在心房颤动患者中使用抗心律失常药物（AAD）来维持窦性心律。我们评估了医疗保健提供者的实际实践与现行指南在 AAD 节律管理一线治疗方面的一致性。
方法和结果 使用匿名 Optum Clinformatics Data Mart 数据库中的行政索赔数据。如果患者在 2015 年至 2016 年期间开始使用 AAD，在首次 AAD 药房索赔前有 1 年的连续数据可用性，并且在此期间有心房颤动的诊断，则将其纳入研究。通过比较医疗保健提供者根据心力衰竭、冠状动脉疾病、两者均有或均无（通过 和 [ 和 ] 代码确定）的存在而发起的 AAD 与指南推荐的一线治疗方案来评估一致性。还通过使用 Medicare 分类代码按提供者类型评估一致性。在纳入的 15445 名患者中，51%的医疗保健提供者使用胺碘酮、18%氟卡尼、15%索他洛尔、8%决奈达隆、5%普罗帕酮和 2%多非利特开始 AAD 治疗。总体指南一致性率为 61%，不同提供者类型之间存在差异：电生理学家为 67%、心脏病专家为 61%、其他医生（如内科医生等）为 60%。
结论 在心房颤动患者的一线节律管理中，实践与指南之间仍然存在相当大的一致性差距。除了为从业者制定增强的 AAD 教育策略外，还需要进一步研究以确定不推荐使用 AAD 的可能原因。
