Daniel Ryan C, Atzema Clare L, Cho Dennis D, Davis Philip J, Costello Lorne L
Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Division of Emergency Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
CJC Open. 2022 Jan 23;4(5):466-473. doi: 10.1016/j.cjco.2022.01.005. eCollection 2022 May.
Both the Canadian Cardiovascular Society (CCS) and the Canadian Association of Emergency Physicians (CAEP) have published documents to guide atrial fibrillation (AF) management. In 2021, the CAEP updated its AF checklist. Prior to this update, the recommendations of the 2 organizations differed in several key areas, including the suggested cardioversion timeframe, the factors determining cardioversion eligibility, and anticoagulant initiation after cardioversion. Whether emergency physicians (EPs) are aware of, or adhering to, one, both, or neither of these documents is unknown.
We assessed document awareness, adherence, and EP practice using a piloted questionnaire administered to EPs at 5 emergency departments in 3 provinces.
Of 166 survey recipients, 123 (74.1%) responded. The majority (64.7%) worked at an academic site, 38.8% identified as female, and median years in practice was 10.0. Most (93.1%) were aware of at least one of the documents; 45.7% were aware of both. Reported awareness was higher for the CCS (77.6%) vs the CAEP (61.2%) guidelines. Respondents varied in their adherence, with 40.5% using parts of both documents. Considerable practice variability occurred when recommendations conflicted. Despite its use not being recommended by either organization, half of respondents (50.0%) reported using the CHADS-VASc score as their stroke-risk assessment tool.
Although most surveyed EPs were aware of at least one organization's AF documents, many reported using parts of both. When recommendations conflicted, EPs were divided in their decision-making. These findings emphasize the need to improve consensus between organizations and further improve knowledge translation.
加拿大心血管学会（CCS）和加拿大急诊医师协会（CAEP）均已发布指导房颤（AF）管理的文件。2021年，CAEP更新了其房颤检查清单。在此次更新之前，这两个组织的建议在几个关键领域存在差异，包括建议的复律时间框架、决定复律资格的因素以及复律后的抗凝启动。急诊医师（EPs）是否知晓、遵循其中一份文件、两份文件或都不遵循尚不清楚。
我们通过向3个省份5个急诊科的急诊医师发放一份经过试点的问卷，评估文件知晓情况、遵循情况以及急诊医师的实践。
在166名调查对象中，123人（74.1%）做出了回应。大多数（64.7%）在学术机构工作，38.8%为女性，从业年限中位数为10.0年。大多数（93.1%）知晓至少一份文件；45.7%知晓两份文件。报告显示，CCS指南（77.6%）的知晓率高于CAEP指南（61.2%）。受访者的遵循情况各不相同，40.5%的人使用了两份文件的部分内容。当建议相互冲突时，出现了相当大的实践差异。尽管两个组织均未推荐使用，但一半的受访者（50.0%）报告使用CHADS-VASc评分作为其卒中风险评估工具。
尽管大多数接受调查的急诊医师知晓至少一个组织的房颤文件，但许多人报告使用了两份文件的部分内容。当建议相互冲突时，急诊医师在决策上存在分歧。这些发现强调了提高组织间共识以及进一步改善知识转化的必要性。
