Provider specialty and atrial fibrillation treatment strategies in United States community practice: findings from the ORBIT-AF registry.
Abstract
BACKGROUND: The prevalence of atrial fibrillation (AF) continues to increase; however,
there are limited data describing the division of care among practitioners in the
community and whether care differs depending on provider specialty. METHODS AND RESULTS:
Using the Outcomes Registry for Better Informed Treatment of AF (ORBIT-AF) Registry,
we described patient characteristics and AF management strategies in ambulatory clinic
practice settings, including electrophysiology (EP), general cardiology, and primary
care. A total of 10 097 patients were included; of these, 1544 (15.3%) were cared
for by an EP provider, 6584 (65.2%) by a cardiology provider, and 1969 (19.5%) by
an internal medicine/primary care provider. Compared with those patients who were
cared for by cardiologists or internal medicine/primary care providers, patients cared
for by EP providers were younger (median age, 73 years [interquartile range, IQR,
64, 80 years, Q1, Q3] versus 75 years [IQR, 67, 82 years] for cardiology and versus
76 years [IQR, 68, 82 years] for primary care). Compared with cardiology and internal
medicine/primary care providers, EP providers used rhythm control (versus rate control)
management more often (44.2% versus 29.7% and 28.8%, respectively, P<0.0001; adjusted
odds ratio [OR] EP versus cardiology, 1.66 [95% confidence interval, CI, 1.05 to 2.61];
adjusted OR for internal medicine/primary care versus cardiology, 0.91 [95% CI, 0.65
to 1.26]). Use of oral anticoagulant therapy was high across all providers, although
it was higher for cardiology and EP providers (overall, 76.1%; P=0.02 for difference
between groups). CONCLUSIONS: Our data demonstrate important differences between provider
specialties, the demographics of the AF patient population treated, and treatment
strategies-particularly for rhythm control and anticoagulation therapy.
Type
Journal articleSubject
ORBIT‐AFantithrombotic therapy
atrial fibrillation
outpatient
provider
specialty
Aged
Aged, 80 and over
Ambulatory Care
Anti-Arrhythmia Agents
Anticoagulants
Atrial Fibrillation
Cardiology
Community Health Services
Female
Humans
Incidence
Internal Medicine
Male
Medicine
Middle Aged
Physicians
Practice Patterns, Physicians'
Prevalence
Primary Health Care
Prospective Studies
Registries
United States
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https://hdl.handle.net/10161/15011Published Version (Please cite this version)
10.1161/JAHA.113.000110Publication Info
Fosbol, Emil L; Holmes, DaJuanicia N; Piccini, Jonathan P; Thomas, Laine; Reiffel,
James A; Mills, Roger M; ... ORBIT-AF Investigators and Patients (2013). Provider specialty and atrial fibrillation treatment strategies in United States community
practice: findings from the ORBIT-AF registry. J Am Heart Assoc, 2(4). pp. e000110. 10.1161/JAHA.113.000110. Retrieved from https://hdl.handle.net/10161/15011.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Eric David Peterson
Fred Cobb, M.D. Distinguished Professor of Medicine
Dr Peterson is the Fred Cobb Distinguished Professor of Medicine in the Division of
Cardiology, a DukeMed Scholar, and the Past Executive Director of the Duke Clinical
Research Institute (DCRI), Durham, NC, USA.
Dr Peterson is the Principal Investigator of the National Institute of Health, Lung
and Blood Institute (NHLBI) Spironolactone Initiation Registry Randomized Interventional
Trial in Heart Failure With Preserved Ejection Fraction (SPIRRIT) Trial He is also
the Principal I
This author no longer has a Scholars@Duke profile, so the information shown here reflects
their Duke status at the time this item was deposited.
Jonathan Paul Piccini Sr.
Associate Professor of Medicine
Jonathan P. Piccini, MD, MHS, FACC, FAHA, FHRS is a clinical cardiac electrophysiologist
and Associate Professor of Medicine with Tenure at Duke University Medical Center
and the Duke Clinical Research Institute. He is the Director of the Cardiac Electrophysiology
section at the Duke Heart Center. His focus is on the care of patients with atrial
fibrillation and complex arrhythmias, with particular emphasis on catheter ablation,
left atrial appendage occlusion, and lead extraction. His resear
Laine Elliott Thomas
Associate Professor of Biostatistics & Bioinformatics
Causal Inference, Heterogeneity of Treatment Effects, Observational Data, Time-varying
Treatments, Real World Evidence
Alphabetical list of authors with Scholars@Duke profiles.

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