PACU Literature Review #10

Hasbrouck M, Nguyen TT. Acute management of atrial fibrillation in congestive heart failure with reduced ejection fraction in the emergency department. Am J Emerg Med. 2022 Apr 6;58:39-42.
PMID: 35623182

STUDY OBJECTIVE

To compare the incidence of adverse effects in the HFrEF patient population whose AF with RVR was treated with IV diltiazem or metoprolol in the ED.

STUDY DESIGN

Single-center, the retrospective review included patients ≥18 years old with HFrEF who presented in AF with RVR and received IV diltiazem or metoprolol in the ED.

Study Intervention & Comparison

IV diltiazem or metoprolol

Results

Primary Outcome
- Overall adverse effects for diltiazem and metoprolol were similar (32% vs. 21%, P = 0.217).

Secondary Outcomes
- Significantly higher incidence of worsening heart failure symptoms within the diltiazem group (33% vs 15%, P = 0.019)
- Rate control failure at 60 min did not differ significantly between diltiazem and metoprolol (51% vs 62%, P = 0.277).

Summary

In HFrEF patients with AF, there was no difference in total adverse events in patients treated with IV diltiazem compared to metoprolol. However, the diltiazem group had a higher incidence of worsening CHF symptoms defined as increased oxygen requirement within four hours or initiation of inotropic support within 48 h.

Additional Readings

PACU Literature Review #10: Acute Management of Atrial Fibrillation in Congestive Heart Failure with Reduced Ejection Fraction in the Emergency Department

Participants 396