دورية أكاديمية
Physicians' perspectives on percutaneous left atrial appendage occlusion for patients with atrial fibrillation.
| العنوان: | Physicians' perspectives on percutaneous left atrial appendage occlusion for patients with atrial fibrillation. |
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| المؤلفون: | Kir D; Department of Cardiovascular Diseases, Mayo Clinic, Rochester MN., Van Houten HK; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN., Walvatne KN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN., Behnken EM; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN., Alkhouli MA; Department of Cardiovascular Diseases, Mayo Clinic, Rochester MN., Graff-Radford J; Department of Neurology, Mayo Clinic, Rochester, MN., Melduni RM; Department of Cardiovascular Diseases, Mayo Clinic, Rochester MN., Gersh BJ; Department of Cardiovascular Diseases, Mayo Clinic, Rochester MN., Friedman PA; Department of Cardiovascular Diseases, Mayo Clinic, Rochester MN., Shah ND; Delta Airlines, Atlanta, GA., Noseworthy PA; Department of Cardiovascular Diseases, Mayo Clinic, Rochester MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN., Yao X; Department of Cardiovascular Diseases, Mayo Clinic, Rochester MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN. Electronic address: yao.xiaoxi@mayo.edu. |
| المصدر: | American heart journal [Am Heart J] 2023 Dec; Vol. 266, pp. 14-24. Date of Electronic Publication: 2023 Aug 10. |
| نوع المنشور: | Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Mosby Country of Publication: United States NLM ID: 0370465 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-6744 (Electronic) Linking ISSN: 00028703 NLM ISO Abbreviation: Am Heart J Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: St. Louis, MO : Mosby |
| مواضيع طبية MeSH: | Atrial Appendage*/surgery , Atrial Fibrillation*/complications , Atrial Fibrillation*/surgery , Physicians* , Stroke*/etiology , Stroke*/prevention & control, Female ; Humans ; Male ; Anticoagulants ; Treatment Outcome |
| مستخلص: | Background: There has been an increasing uptake of transcatheter left atrial appendage occlusion (LAAO) for stroke reduction in atrial fibrillation. Objectives: To investigate the perceptions and approaches among a nationally representative sample of physicians. Methods: Using the American Medical Association Physician Masterfile, we selected a random sample of 500 physicians from each of the specialties: general cardiologists, interventional cardiologists, electrophysiologists, and vascular neurologists. The participants received the survey by mail up to three times from November 9, 2021 to January 14, 2022. In addition to the questions about experiences, perceptions, and approaches, physicians were randomly assigned to 1 of the 4 versions of a patient vignette: white man, white woman, black man, and black woman, to investigate potential bias in decision-making. Results: The top three reasons for considering LAAO were: a history of intracranial bleeding (94.3%), a history of major extracranial bleeding (91.8%), and gastrointestinal lesions (59.0%), whereas the top three reasons for withholding LAAO were: other indications for long-term oral anticoagulation (87.7%), a low bleeding risk (77.0%), and a low stroke risk (65.6%). For the reasons limiting recommendations for LAAO, 59.8% mentioned procedural risks, 42.6% mentioned "limiting efficacy data comparing LAAO to NOAC" and 32.8% mentioned "limited safety data comparing LAAO to NOAC." There was no difference in physicians' decision-making by patients' race, gender, or the concordance between patients' and physicians' race or gender. Conclusions: In the first U.S. national physician survey of LAAO, individual physicians' perspectives varied greatly, which provided information that will help customize future educational activities for different audiences. Condensed Abstract: Although diverse practice patterns of LAAO have been documented, little is known about the reasoning or perceptions that drive these variations. Unlike prior surveys that were directed to Centers that performed LAAO, the current survey obtained insights from individual physicians, not only those who perform the procedures (interventional cardiologists and electrophysiologists) but also those who are closely involved in the decision-making and referral process (general cardiologists and vascular neurologists). The findings identify key evidence gaps and help prioritize future studies to establish a consistent and evidence-based best practice for AF stroke prevention. (Copyright © 2023 Elsevier Inc. All rights reserved.) |
| معلومات مُعتمدة: | R01 AG062436 United States AG NIA NIH HHS |
| المشرفين على المادة: | 0 (Anticoagulants) |
| تواريخ الأحداث: | Date Created: 20230811 Date Completed: 20231121 Latest Revision: 20231121 |
| رمز التحديث: | 20231215 |
| DOI: | 10.1016/j.ahj.2023.07.013 |
| PMID: | 37567353 |
| قاعدة البيانات: | MEDLINE |
Full Text via ClinicalKey 
Full Text Finder | تدمد: | 1097-6744 |
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| DOI: | 10.1016/j.ahj.2023.07.013 |