Atrial fibrillation is a type of an abnormal heart rhythm that is irregular. It is the second most common condition after hypertension in the US. It can result in formation of blood clots in the left atrium (one of the chambers of the heart), that can then break off and lodge in the blood vessels in the brain leading to stroke.
Patients with atrial fibrillation are cared for by a spectrum of clinicians including primary care providers, general cardiologists and cardiology subspecialists called electrophysiologists. Discussions with patients suffering from atrial fibrillation may involve everything from lifestyle changes to prescription of medications that slow the heart rate or change the rhythm or thin the blood to prevent clot formation, and even burning the electrical circuits of the heart in some cases. Regardless of the treatment strategy, clinical outcomes of patients may differ based on specialty of the doctor treating them.
In a study published in the Journal of American College of Cardiology, the authors studied the large Veterans Health Administration database of patients with newly diagnosed atrial fibrillation from 2004 to 2012. Overall, 60% of these patients were managed by primary care only, and 40% received cardiology care. Impressively, patients treated by cardiologists were significantly less likely to suffer from stroke and death compared with those treated by cardiologists. The authors also performed further analyses to understand the reasons behind these differences in outcomes. Cardiology-treated patients were more likely to have received blood-thinning agents within 90 days of diagnosis that might have contributed to lesser incidence of stroke in these patients. Patients treated by cardiologists were also hospitalized more frequently suggesting that overall aggressiveness of care was greater in this group.
For a condition as common and life-threatening as atrial fibrillation, these findings are certainly thought-provoking and warrant implementation of newer healthcare systems that make it easier to provide integrated specialty cardiology care to these patients that may offer greater dissemination of guideline-based therapies.
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