Physicians' knowledge and attitude regarding the new American Heart Association's Guidelines for Infective Endocarditis Prophylaxis

Background: Implementing the recommended guidelines developed by expert physician groups ensures that patients receive the safest care. However, physicians may not be aware of the newest guidelines, or if they are aware, they may be reluctant to change established practice. In 2007, the American Heart Association (AHA) discontinued recommendations for routine dental prophylaxis because it was concluded that the risks of taking preventive antibiotics outweighed the potential benefits. This study seeks to assess physicians' knowledge/acceptance of these new guidelines and explore differences between physicians who accept and do not accept these guidelines.

Methods: An anonymous survey was distributed to 186 primary care physicians, geriatricians, cardiologists, and dentists in 3 major teaching hospitals, during formal departmental rounds (October-November 2007). A univariate analysis was implemented for differences related to antibiotic prophylaxis reported compliance and gender, age groups, nature of specialty, and years of practice.

Results: 186 surveys were completed for data analysis. Most respondents were primary care physicians/geriatricians (47.8%), cardiologists (15.6%), and dentists (11.3%) respectively. A significant portion were male (80%), practicing for less than 10 years (46.2%) in the hospital setting (52.2%). Only 59.1% of physicians were aware that the latest recommendations had been updated in 2007, with 17.2% dating these recommendations to 2006 and 16.1% to 2003. With respect to antibiotic prophylaxis before dental treatments, 40.9% of respondents would prescribe to patients with any kind of congenital heart disease, 47.8% would prescribe to patients with mitral valve prolapse and regurgitation, 66.1% would prescribe to patients with rheumatic heart disease, 94.1% would prescribe to patients with previous history of bacterial endocarditis and 95.7% would prescribe to patients with prosthetic heart valves. When physicians who were aware of the 2007 update were compared to those who did not know, there were significant differences in terms of prescription for congenital heart disease (p<.001), mitral valve prolapse with regurgitation (p<.001), and rheumatic heart disease(p<.001). There were no significant differences for prosthetic heart valve and history of bacterial endocarditis.

Conclusion: The study highlights the lack of awareness of new infective endocarditis prophylaxis guideline updates, thus impacting on the implementation of best clinical practices promoted by the 2007 AHA project. Furthermore, the data identifies specific segments of the physician population that have a lower compliance to these guidelines and suggest educational approaches to physician specific needs based on their personal demographics in order to successfully face the challenge of infective endocarditis prophylaxis in the future.