Évaluation des pratiques professionnelles relatives à la prise en charge de la fibrillation auriculaire en médecine générale dans les Bouches-du-Rhône

Abstract : Introduction: Atrial fibrillation is the most common heart rhythm disorder. Its prevalence is about 1% in the world population. The severity of this arrhythmia is related to the thromboembolic risk and the risk of heart failure, which is a function of the underlying heart disease. The main challenge of treatment is to prevent these accidents, including ischemic strokes. Methods: A quantitative descriptive observational study was led from February to May 2018 to evaluate the practices of general practitioners in Bouches-du-Rhône regarding atrial fibrillation by comparing them with the recommendations of the Haute Autorité de Santé of 2014. Results: 87 general practitioners of the Bouches-du-Rhône region responded to our survey, representing a participation rate of 50.3%. Of the total sample, a small majority (59.6%) adopted an attitude in accordance with the recommendations. Hospitalization criteria, introduction of heart rate depressant therapy and biological monitoring of direct oral anticoagulants are the three elements of the found practices for which practitioners follow the recommendations the least. Experience, proximity to a hospital structure and participation in continuing medical education have a significant influence on the implementation of recommendations. Indeed, our study shows that young or more recently installed doctors adhere better to the recommendations, as do general practitioners far from hospital structures. Participation in continuing medical education is also proving to be a factor of good practice. Discussion: The analysis of these results mainly highlights a lack of training but also an overly easy use of specialists. General practitioners will often prefer to refer to the hospital or wait for the cardiologist's opinion. The intensification of continuing education, the organization of meetings involving cardiologists both for reminders and for the discussion of complex cases, the development of telemedicine for ECG interpretation are all possibilities to be explored in order to optimize the management of patients with AF and to try to reduce the costs associated with avoidable hospitalizations.
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https://dumas.ccsd.cnrs.fr/dumas-02081440
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Submitted on : Wednesday, March 27, 2019 - 3:54:23 PM
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Matthieu Azilazian. Évaluation des pratiques professionnelles relatives à la prise en charge de la fibrillation auriculaire en médecine générale dans les Bouches-du-Rhône. Sciences du Vivant [q-bio]. 2018. ⟨dumas-02081440⟩

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