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