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Provider specialty and atrial fibrillation treatment strategies in United States community practice: findings from the ORBIT-AF registry.

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Date
2013-07-18
Authors
Fosbol, Emil L
Holmes, DaJuanicia N
Piccini, Jonathan P
Thomas, Laine
Reiffel, James A
Mills, Roger M
Kowey, Peter
Mahaffey, Kenneth
Gersh, Bernard J
Peterson, Eric D
ORBIT-AF Investigators and Patients
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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 article
Subject
ORBIT‐AF
antithrombotic 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
Permalink
https://hdl.handle.net/10161/15011
Published Version (Please cite this version)
10.1161/JAHA.113.000110
Publication 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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Scholars@Duke

Peterson

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.
Piccini

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
Thomas

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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