Practice Variation in the Diagnosis and Management of Atrial Fibrillation among Consultants and Residents at a Tertiary Care Hospital in Pakistan

Abstract

Objectives: This study aimed to describe and compare diagnostic approaches, treatment strategies, and anticoagulation practices for atrial fibrillation (AF) among consultants and residents at a tertiary care hospital in Karachi, Pakistan. Methodology: A descriptive, cross-sectional survey was conducted in March 2021 among faculty physicians and postgraduate residents working in the Department of Medicine and allied specialties. A structured, self-administered online questionnaire assessed physicians’ approaches to AF diagnosis, rate and rhythm control strategies, and anticoagulation decision-making. Data were analyzed using descriptive statistics. Results: A total of 104 physicians participated, including 27 consultants and 77 residents. Awareness of different AF types was reported by 85.6% of respondents. Consultants most commonly used a combination of 12-lead electrocardiography (ECG) and pulse examination for diagnosis, whereas residents relied more variably on ECG alone or in combination with pulse assessment. Consultants predominantly favored rhythm control for new-onset AF, while residents more frequently selected rate control strategies. Beta-blockers were the preferred agents for rate control, and amiodarone was the most commonly selected rhythm-control drug in both groups. Risk stratification using CHA₂DS₂-VASc was widely applied, with rivaroxaban emerging as the most frequently chosen anticoagulant. Consultants demonstrated greater awareness of direct oral anticoagulant (DOAC) contraindications and dosing considerations. Considerable variation was observed in anticoagulation practices and post-PCI triple therapy duration. Conclusion: The management of atrial fibrillation shows substantial variability between consultants and residents within a single tertiary care center. These findings highlight the need for standardized, locally adapted, evidence-based protocols and targeted educational interventions to harmonize practice and improve patient outcomes.