Trial Participation Survey

First Name *

Last Name *

Email *

Phone *

Title/role *

Organization/hospital (no abbreviations, please) *

Hospital System Name (no abbreviations please), if applicable

City *

State *

From January 2021 to December 2021, how many patients with newly detected Atrial Fibrillation did the site treat within 120-days of diagnosis? (Estimates acceptable if unable to obtain from GWTG or local registry) *

Which setting does your site see a majority of the first-detected AFib? *

Emergency Department, Observation Unit, Inpatient Services
Outpatient Clinics

Do your current clinical practices include routinely prescribing dronedarone? *

Yes
No

How many patients do you estimate your site will be able to enroll in CHANGE AFib per month? *

On a scale of 1 to 5, with 5 being the highest, how strongly do you feel that CHANGE AFib meets an unmet need? *

On a scale of 1 to 5, with 5 being the highest, please rate your overall enthusiasm for CHANGE AFib. *

General Comments/Questions

CAPTCHA