RHYTHM-AF: design of an international registry on cardioversion of atrial fibrillation and characteristics of participating centers

BACKGROUND Atrial fibrillation is a serious public health problem posing a considerable burden to not only patients, but the healthcare environment due to high rates of morbidity, mortality, and medical resource utilization. There are limited data on the variation in treatment practice patterns across different countries, healthcare settings and the associated health outcomes. METHODS/DESIGN RHYTHM-AF was a prospective observational multinational study of management of recent onset atrial fibrillation patients considered for cardioversion designed to collect data on international treatment patterns and short term outcomes related to cardioversion. We present data collected in 10 countries between May 2010 and June 2011. Enrollment was ongoing in Italy and Brazil at the time of data analysis. Data were collected at the time of atrial fibrillation episode in all countries (Australia, Brazil, France, Germany, Italy, Netherlands, Poland, Spain, Sweden, United Kingdom), and cumulative follow-up data were collected at day 60 (±10) in all but Spain. Information on center characteristics, enrollment data, patient demographics, detail of atrial fibrillation episode, medical history, diagnostic procedures, acute treatment of atrial fibrillation, discharge information and the follow-up data on major events and rehospitalizations up to day 60 were collected. DISCUSSIN A total of 3940 patients were enrolled from 175 acute care centers. 70.5% of the centers were either academic (44%) or teaching (26%) hospitals with an overall median capacity of 510 beds. The sites were mostly specialized with anticoagulation clinics (65.9%), heart failure (75.1%) and hypertension clinics (60.1%) available. The RHYTHM-AF registry will provide insight into regional variability of antiarrhythmic and antithrombotic treatment of atrial fibrillation, the appropriateness of such treatments with respect to outcomes, and their cost-efficacy. Observations will help inform strategies to improve cardiovascular outcomes in patients with atrial fibrillation. TRIAL REGISTRATION Clinical trials NCT01119716Harry JGM Crijns, Lori D Bash, François Chazelle, Jean-Yves Le Heuzey, Thorsten Lewalter, Gregory YH Lip, Aldo P Maggioni, Alfonso Martín, Piotr Ponikowski, Mårten Rosenqvist, Prashanthan Sanders, Mauricio Scanavacca, Alexandra A Bernhardt, Sreevalsa Unniachan, Hemant M Phatak and Anselm K Git

Relationships between beliefs about medications and use of prescribed chronic medications

The purpose of this study was to assess associations between medication beliefs and medication adherence among users of prescribed chronic medications. Under a modified self-regulatory framework, medication adherence is considered as a coping strategy and medication beliefs as factors influencing medication adherence. Patients\u27 medication beliefs were assessed using the Beliefs about Medicines Questionnaire (BMQ) and medication non-adherence was assessed using the Morisky Medication Adherence Scale. Associations between medication beliefs and medication non-adherence were assessed using Pearson correlation and regression analysis. Strengths of associations between beliefs and non-adherence were compared across patients using a different number of chronic medications using Fisher-transformed Pearson correlation estimates and pairwise Tukey\u27s comparison test. Path analysis with latent variables was used to assess fit of the factor structure of associations between medication beliefs and medication non-adherence. Data were collected at outpatient pharmacy of a primary care clinic affiliated with a hospital in Indianapolis, IN. Study participants were sought from patients waiting to see their pharmacists. Eligibility criteria were continuous use of prescribed medications for at least two months prior to completion of the survey and ability to comfortably read and complete a survey in English. A response rate for this study was 78.3 percent. Specific necessity to use medications had a negative but insignificant association with medication non-adherence; whereas, specific concerns related to medications, perceived general overuse of medications by prescribers and general harmful nature of medications had significant positive associations with medication non-adherence. When relative strengths of associations between medication beliefs and non-adherence were assessed, only specific-necessity and specific-concerns exhibited significant associations with medication non-adherence. Strengths of associations between beliefs and non-adherence were similar across patients using different numbers of chronic medications, which indicated that the BMQ effectively assessed medication beliefs across patients using different number of chronic medications. Path analysis indicated that specific-necessity, specific-concerns and general-overuse were able to predict 26.3 percent of the variance in medication non-adherence. General-harm and specific-necessity accounted for 54.8 percent of variance in specific-concerns. Medication beliefs assessment can be used to detect problems related to medication use