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Am J Health Syst Pharm. 2016 Dec 15;73(24):2068-2076.

Diltiazem versus metoprolol for rate control in atrial fibrillation with rapid ventricular response in the emergency department.

Author information

1
Department of Pharmacy Services, University of Maryland Medical Center, Baltimore, MD. hinesmc@gmail.com.
2
Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD.
3
Center for Translational Medicine, University of Maryland School of Pharmacy, Baltimore, MD.
4
Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD.
5
Department of Pharmacy, Massachusetts General Hospital, Boston, MA.
6
Department of Emergency Medicine, Harvard Medical School, Boston, MA.

Abstract

PURPOSE:

The impact of patient-specific factors on the choice of β-blocker versus calcium channel blocker therapy for rate control in emergency department (ED) patients treated for atrial fibrillation (AF) was investigated.

METHODS:

A retrospective cohort study was conducted to evaluate the influence of demographics, prior medication use, hemodynamic and clinical characteristics, and other variables on selection of first-line therapy for AF among patients admitted to the ED of an academic medical center over a 22-month period (October 2012-July 2014) who received i.v. treatment with either the β-blocker metoprolol (n = 45) or the calcium channel blocker diltiazem (n = 55) for rate control.

RESULTS:

Significant predictors of the selection of metoprolol versus diltiazem included a past history of AF (odds ratio [OR], 8.3; 95% confidence interval [CI], 1.396-72.713; p = 0.032) or diabetes mellitus (OR, 7.2; 95% CI, 1.208-58.490; p = 0.042) and being prescribed a β-blocker prior to presentation (OR, 27.8; 95% CI, 4.704-272.894; p = 0.001); a history of calcium channel blocker use prior to ED presentation was a negative predictor of β-blocker use for initial rate control (OR, 0.1; 95% CI, 0.005-0.265; p = 0.002). No differences in the effectiveness or safety of diltiazem and metoprolol were identified. Indicators of hemodynamic and clinical response to ED management were not predictive of discharge medication selection.

CONCLUSION:

The drug class used for rate control prior to ED admission was the most significant predictor of medication selection for rate control in the ED setting.

KEYWORDS:

atrial fibrillation; calcium channel blocker; emergency department; rate control; β-blocker

PMID:
27919874
DOI:
10.2146/ajhp160126
[Indexed for MEDLINE]

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