@article{5a17800080594abda2a6b6d8627d6531,
title = "Current practice and attitudes of stroke physicians towards rhythm-control therapy for stroke prevention: results of an international survey",
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.",
author = "M{\"a}rit Jensen and {Al-Shahi salman}, Rustam and Ng, {G. andre} and {Van der worp}, {H. bart} and Peter Loh and Campbell, {Bruce c. v.} and Kalman, {Jonathan m.} and Hill, {Michael d.} and Sposato, {Luciano a.} and Andrade, {Jason g.} and Andreas Metzner and Paulus Kirchhof and G{\"o}tz Thomalla",
note = "Funding Information: Dr Al-Shahi Salman reported personal fees from Recursion Pharmaceuticals Consultancy paid to The University of Edinburgh and personal fees from Bioxodes Consultancy paid to The University of Edinburgh outside the submitted work. Dr van der Worp received fees for consultation for Bayer and LivaNova, all paid to his institution. Dr Loh is a consultant for Abbott and has research contracts with Abbott. Dr Campbell is a member of the Editorial Board of Neurological Research and Practice. Dr Hill reports personal fees from Sun Pharma, grants to the University of Calgary from Boehringer Ingelheim, NoNO Inc, Medtronic LLC, outside the submitted work, has a patent US Patent office Number: 62/086,077 licensed to Circle Neurovascular Inc., and a patent US Patent office Number: US 10,916,346 licensed to Circle Neurovascular Inc., and owns stock in Pure Web Incorporated, a company that makes, among other products, medical imaging software, is a director of the Canadian Federation of Neurological Sciences, a not-for-profit group, a director of the Canadian Stroke Consortium, a not-for-profit group, is a director of Circle NeuroVascular Inc., and has received grant support from Alberta Innovates, CIHR, Heart and Stroke Foundation of Canada, National Institutes of Neurological Disorders and Stroke. Dr Andrade reports grants and personal fees from Medtronic, Bristol Myers Squibb (BMS), Pfizer, Bayer, and Servier. Dr Kirchhof receives research support for basic, translational, and clinical research projects from European Union, British Heart Foundation, Leducq Foundation, Medical Research Council (UK), and German Centre for Cardiovascular Research, from several drug and device companies active in atrial fibrillation and has received honoraria from several such companies in the past, but not in the last three years. Paulus Kirchhof is listed as inventor on two patents held by University of Birmingham (Atrial Fibrillation Therapy WO 2015140571, Markers for Atrial Fibrillation WO 2016012783). Dr Thomalla reports personal fees from Acandis, Alexion, Amarin, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, Daiichi Sankyo, Portola, and Stryker outside the submitted work. He serves as a section editor for Neurological Research and Practice. All other authors report no conflicts of interest. Publisher Copyright: {\textcopyright} 2023, The Author(s).",
year = "2023",
month = jul,
day = "6",
doi = "10.1186/s42466-023-00255-7",
language = "English",
volume = "5",
journal = "Neurological Research and Practice",
issn = "2524-3489",
publisher = "BioMed Central",
number = "1",
}