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Attitudes toward anticoagulation for postoperative atrial fibrillation: A nationwide survey of VA providers
Author(s) -
Riad Fady S.,
German Konstantin,
Deitz Sarah,
Sahadevan Jayakumar,
Sundaram Varun,
Waldo Albert L.
Publication year - 2020
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.14095
Subject(s) - medicine , atrial fibrillation , medical emergency , medline , emergency medicine , cardiology , intensive care medicine , political science , law
Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery. Though often felt to be self‐limited, this complication has been associated with increases in both short and long‐term stroke and mortality. Several studies have also shown a high rate of AF recurrence. Optimal treatment strategy is not yet defined, and the role of anticoagulation (AC) is unclear. Our objective was to determine provider attitudes toward management of this common complication. Methods A survey consisting of 15 multiple choice questions was distributed to providers at Veterans Healthcare Administration hospitals nationwide. Results The majority of respondents were cardiologists. Practices varied drastically with respect to AC use for patients with POAF who were discharged in normal sinus rhythm. Less variability existed for patients discharged in AF. There was no clear consensus regarding other factors to consider when deciding on AC therapy, including length of episode, or risk factors for stroke such as CHA 2 DS 2 ‐VASc score. There was also no consensus on duration of therapy or need for post discharge cardiac monitoring. Conclusion Our data indicate a wide variability in the management of POAF. This reflects conflicting recommendations in the guidelines, as well as a paucity of prospective treatment trials in this field. Nevertheless, a growing evidence base suggests that this complication carries potentially serious long‐term morbidity and mortality, and better evidence for its management is needed.