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Current practice and attitudes of stroke physicians towards rhythm-control therapy for stroke prevention : results of an international survey Jensen, Märit; Al-Shahi Salman, Rustam; Ng, G. Andre; van der Worp, H. Bart; Loh, Peter; Campbell, Bruce C. V.; Kalman, Jonathan M.; Hill, Michael D.; Sposato, Luciano A.; Andrade, Jason; Metzner, Andreas; Kirchhof, Paulus; Thomalla, Götz

Abstract

Background: Patients with ischemic stroke and atrial fibrillation (AF) are at particularly high risk for recurrent stroke and cardiovascular events. Early rhythm control has been shown to be superior to usual care for the prevention of stroke and cardiovascular events for people with early AF. There are no data on the willingness to use rhythm control for patients with AF and acute ischemic stroke in clinical practice. Methods: An online survey was carried out among stroke physicians to assess current practice and attitudes toward rhythm control in patients with AF and acute ischemic stroke between December 22nd 2021 and March 24th 2022. Results: The survey was completed by 277 physicians including 237 from 15 known countries and 40 from unspecified countries. 79% (210/266) reported that they do not regularly apply treatment for rhythm control by ablation or antiarrhythmic drugs at all or only in small numbers (≤ 10%) of patients with AF and acute ischemic stroke. In those patients treated with rhythm-control therapy, antiarrhythmic drugs were used by the majority of respondents (89%), while only a minority reported using AF ablation (11%). 88% of respondents (221/250) stated that they would be willing to randomize patients with AF after acute ischemic stroke to either early rhythm control or usual care in a clinical trial. Conclusion: Despite its potential benefit, few patients with AF and acute ischemic stroke appear to be treated with rhythm control, which may result from uncertainty regarding potential complications of antiarrhythmic therapy in patients with acute stroke. Together with recent data on the effectiveness of early rhythm control in patients with a history of stroke, these results call for a randomized clinical trial to assess the efficacy of early rhythm control in patients with acute ischemic stroke and AF.

Item Metadata

Title
Current practice and attitudes of stroke physicians towards rhythm-control therapy for stroke prevention : results of an international survey
Creator
Jensen, Märit; Al-Shahi Salman, Rustam; Ng, G. Andre; van der Worp, H. Bart; Loh, Peter; Campbell, Bruce C. V.; Kalman, Jonathan M.; Hill, Michael D.; Sposato, Luciano A.; Andrade, Jason; Metzner, Andreas; Kirchhof, Paulus; Thomalla, Götz
Contributor
Centre for Cardiovascular Innovation
Publisher
BioMed Central
Date Issued
2023-07-06
Description
Background: Patients with ischemic stroke and atrial fibrillation (AF) are at particularly high risk for recurrent stroke and cardiovascular events. Early rhythm control has been shown to be superior to usual care for the prevention of stroke and cardiovascular events for people with early AF. There are no data on the willingness to use rhythm control for patients with AF and acute ischemic stroke in clinical practice. Methods: An online survey was carried out among stroke physicians to assess current practice and attitudes toward rhythm control in patients with AF and acute ischemic stroke between December 22nd 2021 and March 24th 2022. Results: The survey was completed by 277 physicians including 237 from 15 known countries and 40 from unspecified countries. 79% (210/266) reported that they do not regularly apply treatment for rhythm control by ablation or antiarrhythmic drugs at all or only in small numbers (≤ 10%) of patients with AF and acute ischemic stroke. In those patients treated with rhythm-control therapy, antiarrhythmic drugs were used by the majority of respondents (89%), while only a minority reported using AF ablation (11%). 88% of respondents (221/250) stated that they would be willing to randomize patients with AF after acute ischemic stroke to either early rhythm control or usual care in a clinical trial. Conclusion: Despite its potential benefit, few patients with AF and acute ischemic stroke appear to be treated with rhythm control, which may result from uncertainty regarding potential complications of antiarrhythmic therapy in patients with acute stroke. Together with recent data on the effectiveness of early rhythm control in patients with a history of stroke, these results call for a randomized clinical trial to assess the efficacy of early rhythm control in patients with acute ischemic stroke and AF.
Subject
Atrial fibrillation; Stroke; Rhythm-control therapy; Online survey
Genre
Article
Type
Text
Language
eng
Date Available
2023-07-24
Provider
Vancouver : University of British Columbia Library
Rights
Attribution 4.0 International (CC BY 4.0)
DOI
10.14288/1.0434272
URI
http://hdl.handle.net/2429/85302
Affiliation
Medicine, Faculty of; Non UBC; Medicine, Department of
Citation
Neurological Research and Practice. 2023 Jul 06;5(1):29
Publisher DOI
10.1186/s42466-023-00255-7
Peer Review Status
Reviewed
Scholarly Level
Faculty; Researcher; Other
Copyright Holder
The Author(s)
Rights URI
http://creativecommons.org/licenses/by/4.0/
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Attribution 4.0 International (CC BY 4.0)