Clinical Research Atrial Fibrillation Care: Challenges in Clinical Practice and Educational Needs Assessment Suzanne Murray, BA, a Patrice Lazure, MSc, a Carolyn Pullen, RN, BScN, PhD(c), b Paule Maltais, BSc, c and Paul Dorian, MD, FRCPC d,e a AXDEV Group Inc., Brossard, Que ´bec, Canada b Canadian Cardiovascular Society, Ottawa, Ontario, Canada c sanofi-aventis Canada, Laval, Que ´bec, Canada d University of Toronto, Toronto, Ontario, Canada e St-Michaels’ Hospital, Toronto, Ontario, Canada 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 underly- ing causes of these gaps. Methods: A mixed-method approach --consisting of qualitative (semi- structured interviews) and quantitative data collection techniques (on- line 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 knowl- edge gaps across the care continuum, including screening, diagnosis, and treatment. Clinical decision-making, individualized patient ther- apy, communication with patients and between professionals, and RÉSUMÉ Introduction : Les de ´bats actuels sur le choix d’une strate ´gie de prise en charge des patients souffrant de la fibrillation auriculaire, combine ´s a ` l’efficacite ´ limite ´e et aux effets inde ´sirables fre ´quents de la pharma- cothe ´rapie actuelle, entraı ˆnent de l’incertitude et de la confusion, ce qui va a ` l’encontre de la prestation optimale des soins de sante ´a ` ces patients. Objectifs : De ´terminer les lacunes sur le plan des connaissances, des aptitudes et des compe ´tences des me ´decins du Canada qui traitent des patients pre ´sentant une fibrillation auriculaire, ainsi que les causes sous-jacentes a ` ces lacunes. Me ´thodes : Une e ´valuation des besoins a e ´te ´ effectue ´e avec les méth- ode mixtes qualitatives (entrevues semi-structurées) et des techniques de recueil de donne ´es quantitatives (sondage en ligne). Les re ´sultats ont e ´te ´ triangule ´s pour s’assurer de la fiabilite ´ et de la ve ´racite ´. L’e ´chantillon combine ´ (n = 161) comprenait 43 me ´decins de famille/ge ´ne ´ralistes, 23 spe ´cialistes en me ´decine interne, 48 cardiologues, 28 urgentologues, 14 neurologues et 5 patients. Re ´sultats : Les lacunes et les obstacles qui entravent la prestation optimale des soins e ´taient lie ´s a ` l’impre ´cision de la de ´finition de la fibrillation auriculaire, au caracte `re incertain de la pathophysiologie et Atrial fibrillation (AF) is the most common sustained arrhyth- mia treated in clinical practice. The irregular heart rate can cause palpitations, shortness of breath, and fatigue, and AF can lead to heart failure or stroke. The lifetime risk of developing AF in individuals 40 years and older is 1:4 1 and is associated with substantial morbidity. Recent guidelines from the European Society of Cardiology and the Canadian Cardiovascular Society (CCS) enunciate the current understanding of AF and provide recommendations for treatment and management strategies. The guidelines em- phasize that AF is a multifaceted disorder with many causes and different clinical manifestations in which the treatment target is not straightforward. Current guidelines highlight that clini- cal outcomes are not solely related to the frequency or duration of AF episodes, causing additional confusion and difficulties for clinicians in making decisions about management strategy in everyday practice. The CCS’s most recent recommendations on the diagnosis and management of AF were published in 2005. 2 Since then, Received for publication October 15, 2010. Accepted November 8, 2010. Corresponding author: Patrice Lazure, AXDEV Group Inc, 210-8, Place- du-Commerce, Brossard, Québec, Canada, J4W 3H2. Tel.: +1-450-465- 2011/+1-888-282-9338, fax: +1-450-465-1155. E-mail: lazurep@axdevgroup.com See page 103 for disclosure information. Canadian Journal of Cardiology 27 (2011) 98 –104 0828-282X/$ – see front matter © 2011 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved. doi:10.1016/j.cjca.2010.12.006