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Am J Emerg Med. 2019 Nov 15. pii: S0735-6757(19)30631-X. doi: 10.1016/j.ajem.2019.09.020. [Epub ahead of print]

Weight-based versus non-weight-based diltiazem dosing in the setting of atrial fibrillation with rapid ventricular response.

Author information

1
Department of Pharmacy, Medical University of South Carolina, United States; Medical University of South Carolina College of Pharmacy, Charleston, SC, United States.
2
Medical University of South Carolina College of Pharmacy, Charleston, SC, United States.
3
Department of Emergency Medicine, Medical University of South Carolina, United States.
4
Department of Pharmacy, Medical University of South Carolina, United States; Medical University of South Carolina College of Pharmacy, Charleston, SC, United States. Electronic address: weant@musc.edu.

Abstract

PURPOSE:

There is conflicting evidence to support the superiority of weight-based (WB) dosing of intravenous (IV) diltiazem over non-weight-based (NWB) dosing strategies in the management of atrial fibrillation (AFib) with rapid ventricular response (RVR).

METHODS:

A retrospective review evaluated patients presenting to the emergency department (ED) in AFib with RVR and receiving IV diltiazem from 2015 to 2018. Those receiving a NWB dose were compared with those receiving a WB dose based on actual body weight (ABW). Secondary analyses evaluated safety profiles of the regimens and compared response in groups defined by ABW or ideal body weight (IBW).

RESULTS:

A total of 371 patients were included in the analysis. No significant difference was observed in achieving a therapeutic response (66.5% vs. 73.1%, p = 0.18) or adverse events between the groups. Patients receiving a WB dose were significantly more likely to have a HR < 100 bpm than those receiving a NWB dose (40.9% vs. 53.5%, p = 0.01). When groups were defined by IBW, WB dosing was associated with a significantly higher incidence of achieving a therapeutic response (62.7% vs. 74.3%, p = 0.02).

CONCLUSION:

In patients presenting with AF with RVR, there was no significant difference in achieving a therapeutic response between the two strategies. A WB dosing approach did result in a greater proportion of patients with a HR < 100 bpm. The utilization of IBW for WB dosing may result in an increased achievement of a therapeutic response.

KEYWORDS:

Atrial fibrillation; Diltiazem; Emergency medicine; Obesity; Pharmacy; Rate control

PMID:
31753621
DOI:
10.1016/j.ajem.2019.09.020

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