Evaluation of metoprolol versus diltiazem for rate control of atrial fibrillation in the emergency department
The purpose of this study was to compare the effectiveness and safety of the metoprolol and diltiazem administration in the Emergency Department (ED) for rate control of supraventricular tachycardia. This was a retrospective cohort study of adult patients who presented to the ED with ventricular rat...
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| Veröffentlicht in: | The American journal of emergency medicine 2021-08, Vol.46, p.585-590 |
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| creator | McGrath, Patrick Kersten, Brian Chilbert, Maya R. Rusch, Caroline Nadler, Megan |
| description | The purpose of this study was to compare the effectiveness and safety of the metoprolol and diltiazem administration in the Emergency Department (ED) for rate control of supraventricular tachycardia.
This was a retrospective cohort study of adult patients who presented to the ED with ventricular rates ≥120 beats per minute (bpm) and who received bolus doses of either intravenous metoprolol or intravenous diltiazem. The primary outcome was achievement of rate control, defined as heart rate < 110 bpm, at two hours after administration of the last bolus dose of metoprolol or diltiazem. Safety outcomes included occurrence of hypotension, defined as systolic blood pressure |
| doi_str_mv | 10.1016/j.ajem.2020.11.039 |
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This was a retrospective cohort study of adult patients who presented to the ED with ventricular rates ≥120 beats per minute (bpm) and who received bolus doses of either intravenous metoprolol or intravenous diltiazem. The primary outcome was achievement of rate control, defined as heart rate < 110 bpm, at two hours after administration of the last bolus dose of metoprolol or diltiazem. Safety outcomes included occurrence of hypotension, defined as systolic blood pressure < 90 mmHg or diastolic blood pressure < 60 mmHg, and bradycardia, defined as heart rate < 60 bpm.
There were 166 patients receiving metoprolol and 183 patients receiving diltiazem included in the study. The primary outcome, rate control at two hours after the last bolus dose of metoprolol or diltiazem was similar between the two groups (45.8% vs 42.6%, p = 0.590, respectively). The percentage of patients achieving rate control was also similar (47.0% vs 41.6%, p = 0.333) at one hour. At 0.5 h HR had a significantly greater numerical (diltiazem: 29.3 ± 23.1 bpm vs metoprolol: 21.8 ± 18.9 bpm, p = 0.012) and percent decrease (21.1% vs 15.94%, p = 0.014) in the diltiazem group compared to metoprolol. There was no significant difference in occurrence of bradycardia in the two groups (diltiazem: 3.83% vs metoprolol: 1.2%, p = 0.179). More patients in the diltiazem group compared to the metoprolol group experienced hypotension (39.3% vs 23.5%, p = 0.002). The difference in systolic hypotension events was not significantly different (9.29% vs 5.42%, p = 0.221), while the difference in diastolic hypotension events was significantly different (37.7% vs 22.3%, p = 0.002).
There was no difference in acute rate control effectiveness two hours after the last bolus dose of diltiazem and metoprolol for supraventricular tachycardias. There was a significantly higher occurrence of hypotension in the diltiazem group which was driven by higher rates of diastolic blood pressures less than 60 mmHg.</description><identifier>ISSN: 0735-6757</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2020.11.039</identifier><language>eng</language><publisher>Philadelphia: Elsevier Inc</publisher><subject>Atrial fibrillation ; Blood pressure ; Bradycardia ; Cardiac arrhythmia ; Cardioversion ; Diltiazem ; Drug dosages ; Ejection fraction ; Emergency medical care ; Fibrillation ; Heart rate ; Hypotension ; Intravenous administration ; Length of stay ; Metoprolol ; Patients ; Performance evaluation ; Pharmacokinetics ; Rate control ; Systematic review ; Tachycardia ; Ventricle</subject><ispartof>The American journal of emergency medicine, 2021-08, Vol.46, p.585-590</ispartof><rights>2020 Elsevier Inc.</rights><rights>2020. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c361t-d0e0aba05b09ca56fb36e05d3aa1d634596dc6bd615a0f0b6120066fdb1e26293</citedby><cites>FETCH-LOGICAL-c361t-d0e0aba05b09ca56fb36e05d3aa1d634596dc6bd615a0f0b6120066fdb1e26293</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2555958041?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids></links><search><creatorcontrib>McGrath, Patrick</creatorcontrib><creatorcontrib>Kersten, Brian</creatorcontrib><creatorcontrib>Chilbert, Maya R.</creatorcontrib><creatorcontrib>Rusch, Caroline</creatorcontrib><creatorcontrib>Nadler, Megan</creatorcontrib><title>Evaluation of metoprolol versus diltiazem for rate control of atrial fibrillation in the emergency department</title><title>The American journal of emergency medicine</title><description>The purpose of this study was to compare the effectiveness and safety of the metoprolol and diltiazem administration in the Emergency Department (ED) for rate control of supraventricular tachycardia.
This was a retrospective cohort study of adult patients who presented to the ED with ventricular rates ≥120 beats per minute (bpm) and who received bolus doses of either intravenous metoprolol or intravenous diltiazem. The primary outcome was achievement of rate control, defined as heart rate < 110 bpm, at two hours after administration of the last bolus dose of metoprolol or diltiazem. Safety outcomes included occurrence of hypotension, defined as systolic blood pressure < 90 mmHg or diastolic blood pressure < 60 mmHg, and bradycardia, defined as heart rate < 60 bpm.
There were 166 patients receiving metoprolol and 183 patients receiving diltiazem included in the study. The primary outcome, rate control at two hours after the last bolus dose of metoprolol or diltiazem was similar between the two groups (45.8% vs 42.6%, p = 0.590, respectively). The percentage of patients achieving rate control was also similar (47.0% vs 41.6%, p = 0.333) at one hour. At 0.5 h HR had a significantly greater numerical (diltiazem: 29.3 ± 23.1 bpm vs metoprolol: 21.8 ± 18.9 bpm, p = 0.012) and percent decrease (21.1% vs 15.94%, p = 0.014) in the diltiazem group compared to metoprolol. There was no significant difference in occurrence of bradycardia in the two groups (diltiazem: 3.83% vs metoprolol: 1.2%, p = 0.179). More patients in the diltiazem group compared to the metoprolol group experienced hypotension (39.3% vs 23.5%, p = 0.002). The difference in systolic hypotension events was not significantly different (9.29% vs 5.42%, p = 0.221), while the difference in diastolic hypotension events was significantly different (37.7% vs 22.3%, p = 0.002).
There was no difference in acute rate control effectiveness two hours after the last bolus dose of diltiazem and metoprolol for supraventricular tachycardias. There was a significantly higher occurrence of hypotension in the diltiazem group which was driven by higher rates of diastolic blood pressures less than 60 mmHg.</description><subject>Atrial fibrillation</subject><subject>Blood pressure</subject><subject>Bradycardia</subject><subject>Cardiac arrhythmia</subject><subject>Cardioversion</subject><subject>Diltiazem</subject><subject>Drug dosages</subject><subject>Ejection fraction</subject><subject>Emergency medical care</subject><subject>Fibrillation</subject><subject>Heart rate</subject><subject>Hypotension</subject><subject>Intravenous administration</subject><subject>Length of stay</subject><subject>Metoprolol</subject><subject>Patients</subject><subject>Performance evaluation</subject><subject>Pharmacokinetics</subject><subject>Rate control</subject><subject>Systematic review</subject><subject>Tachycardia</subject><subject>Ventricle</subject><issn>0735-6757</issn><issn>1532-8171</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kUFr3DAQhUVJIJtt_kBOglx68WZGtrRr6KUsaRMI9NKehSyNUxnb2kjyQvrro2V76iGngeF7jzfzGLtF2CCguh82ZqBpI0CUBW6gbj-xFcpaVDvc4gVbwbaWldrK7RW7TmkAQGxks2LTw9GMi8k-zDz0fKIcDjGMYeRHimlJ3Pkxe_OXJt6HyKPJxG2Yc2FOvMnRm5H3vot-HM82fub5D3GaKL7QbN-4o4OJeaI5f2aXvRkT3fyba_b7-8Ov_WP1_PPH0_7bc2VrhblyQGA6A7KD1hqp-q5WBNLVxqBTdSNb5azqnEJpoIdOoQBQqncdklCirdfsy9m33PK6UMp68slSSThTWJIWjVLQwE6qgt79hw5hiXNJp4WUspU7aLBQ4kzZGFKK1OtD9JOJbxpBnxrQgz41oE8NaERdGiiir2cRlVOPnqJO1pePkPORbNYu-I_k7-tnkLk</recordid><startdate>202108</startdate><enddate>202108</enddate><creator>McGrath, Patrick</creator><creator>Kersten, Brian</creator><creator>Chilbert, Maya R.</creator><creator>Rusch, Caroline</creator><creator>Nadler, Megan</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>202108</creationdate><title>Evaluation of metoprolol versus diltiazem for rate control of atrial fibrillation in the emergency department</title><author>McGrath, Patrick ; Kersten, Brian ; Chilbert, Maya R. ; Rusch, Caroline ; Nadler, Megan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c361t-d0e0aba05b09ca56fb36e05d3aa1d634596dc6bd615a0f0b6120066fdb1e26293</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Atrial fibrillation</topic><topic>Blood pressure</topic><topic>Bradycardia</topic><topic>Cardiac arrhythmia</topic><topic>Cardioversion</topic><topic>Diltiazem</topic><topic>Drug dosages</topic><topic>Ejection fraction</topic><topic>Emergency medical care</topic><topic>Fibrillation</topic><topic>Heart rate</topic><topic>Hypotension</topic><topic>Intravenous administration</topic><topic>Length of stay</topic><topic>Metoprolol</topic><topic>Patients</topic><topic>Performance evaluation</topic><topic>Pharmacokinetics</topic><topic>Rate control</topic><topic>Systematic review</topic><topic>Tachycardia</topic><topic>Ventricle</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McGrath, Patrick</creatorcontrib><creatorcontrib>Kersten, Brian</creatorcontrib><creatorcontrib>Chilbert, Maya R.</creatorcontrib><creatorcontrib>Rusch, Caroline</creatorcontrib><creatorcontrib>Nadler, Megan</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McGrath, Patrick</au><au>Kersten, Brian</au><au>Chilbert, Maya R.</au><au>Rusch, Caroline</au><au>Nadler, Megan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation of metoprolol versus diltiazem for rate control of atrial fibrillation in the emergency department</atitle><jtitle>The American journal of emergency medicine</jtitle><date>2021-08</date><risdate>2021</risdate><volume>46</volume><spage>585</spage><epage>590</epage><pages>585-590</pages><issn>0735-6757</issn><eissn>1532-8171</eissn><abstract>The purpose of this study was to compare the effectiveness and safety of the metoprolol and diltiazem administration in the Emergency Department (ED) for rate control of supraventricular tachycardia.
This was a retrospective cohort study of adult patients who presented to the ED with ventricular rates ≥120 beats per minute (bpm) and who received bolus doses of either intravenous metoprolol or intravenous diltiazem. The primary outcome was achievement of rate control, defined as heart rate < 110 bpm, at two hours after administration of the last bolus dose of metoprolol or diltiazem. Safety outcomes included occurrence of hypotension, defined as systolic blood pressure < 90 mmHg or diastolic blood pressure < 60 mmHg, and bradycardia, defined as heart rate < 60 bpm.
There were 166 patients receiving metoprolol and 183 patients receiving diltiazem included in the study. The primary outcome, rate control at two hours after the last bolus dose of metoprolol or diltiazem was similar between the two groups (45.8% vs 42.6%, p = 0.590, respectively). The percentage of patients achieving rate control was also similar (47.0% vs 41.6%, p = 0.333) at one hour. At 0.5 h HR had a significantly greater numerical (diltiazem: 29.3 ± 23.1 bpm vs metoprolol: 21.8 ± 18.9 bpm, p = 0.012) and percent decrease (21.1% vs 15.94%, p = 0.014) in the diltiazem group compared to metoprolol. There was no significant difference in occurrence of bradycardia in the two groups (diltiazem: 3.83% vs metoprolol: 1.2%, p = 0.179). More patients in the diltiazem group compared to the metoprolol group experienced hypotension (39.3% vs 23.5%, p = 0.002). The difference in systolic hypotension events was not significantly different (9.29% vs 5.42%, p = 0.221), while the difference in diastolic hypotension events was significantly different (37.7% vs 22.3%, p = 0.002).
There was no difference in acute rate control effectiveness two hours after the last bolus dose of diltiazem and metoprolol for supraventricular tachycardias. There was a significantly higher occurrence of hypotension in the diltiazem group which was driven by higher rates of diastolic blood pressures less than 60 mmHg.</abstract><cop>Philadelphia</cop><pub>Elsevier Inc</pub><doi>10.1016/j.ajem.2020.11.039</doi><tpages>6</tpages></addata></record> |
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| source | Access via ScienceDirect (Elsevier); ProQuest Central UK/Ireland |
| subjects | Atrial fibrillation Blood pressure Bradycardia Cardiac arrhythmia Cardioversion Diltiazem Drug dosages Ejection fraction Emergency medical care Fibrillation Heart rate Hypotension Intravenous administration Length of stay Metoprolol Patients Performance evaluation Pharmacokinetics Rate control Systematic review Tachycardia Ventricle |
| title | Evaluation of metoprolol versus diltiazem for rate control of atrial fibrillation in the emergency department |
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