OBJECTIVES--To assess how the opinions of cardiologists, physicians, and general practitioners on the indications for permanent pacing compare with published guidelines, and to determine whether resources, pacing experience, and position influence referral practices. DESIGN--Anonymous postal survey by questionnaire from St Bartholomew's Hospital, London and the King's Fund Institute, London. The questionnaire established the respondent's position, resources, and previous pacing experience. Eleven clinical and electrocardiographic situations were described and respondents were asked to decide on whether pacing was indicated. The responses received were compared with the guidelines provided by the 1984 American College of Cardiology/American Heart Association task force. PARTICIPANTS--The 630 members of the British Cardiac Society, 1370 randomly selected general physicians, and 2000 general practitioners. RESULTS--Patients with symptoms were more likely to be referred for pacing than symptom free patients regardless of underlying aetiology. In relatively symptom free patients the frequency with which pacing was recommended was low, even when it was unequivocally indicated on prognostic grounds. Failure to recommend pacing was unrelated to diagnostic facilities or referral difficulties. Respondents with pacing experience were more likely to recommend pacing. CONCLUSIONS--The physicians surveyed had a conservative approach towards recommending pacing. Most physicians were influenced predominantly by symptoms and the prognostic indications for pacing were not well appreciated.
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