Atrial fibrillation care: challenges in clinical practice and educational needs assessment

Abstract

Background: Current debates around the choice of management strategy for patients with atrial fibrillation (AF) combined with limited efficacy and frequent adverse effects of current pharmacotherapies cause uncertainty and confusion, challenging optimal care delivery to AF patients.

Objectives: To determine gaps in knowledge, skill, and competencies of Canadian physicians caring for patients with AF as well as underlying causes of these gaps.

Methods: A mixed-method approach --consisting of qualitative (semistructured interviews) and quantitative data collection techniques (online survey) --was conducted. Findings were triangulated to ensure the reliability and trustworthiness of findings. The combined sample (n = 161) included 43 family physicians/general practitioners, 23 internal medicine specialists, 48 cardiologists, 28 emergency physicians, 14 neurologists, and 5 patients.

Results: Gaps and barriers impeding optimal care were related to an unclear definition of AF, uncertainty of its pathophysiology, and knowledge gaps across the care continuum, including screening, diagnosis, and treatment. Clinical decision-making, individualized patient therapy, communication with patients and between professionals, and application of guidelines were found to be particularly challenging. These issues are discussed in the context of the newly revised Canadian Cardiovascular Society (CCS) AF Guidelines.

Conclusions: Educational gaps exist across the entire continuum of care. Results from this study, along with the 2011 CCS guidelines for AF management, provide direction for solutions through physician education and professional development.