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Safety and Efficiency of Calcium Channel Blockers Versus Beta‐blockers for Rate Control in Patients With Atrial Fibrillation and No Acute Underlying Medical Illness
Author(s) -
Scheuermeyer Frank Xavier,
Grafstein Eric,
Stenstrom Rob,
Christenson Jim,
Heslop Claire,
Heilbron Brett,
McGrath Lorraine,
Innes Grant
Publication year - 2013
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.12091
Subject(s) - medicine , atrial fibrillation , stroke (engine) , emergency department , retrospective cohort study , adverse effect , emergency medicine , medical record , mechanical engineering , psychiatry , engineering
Objectives Many patients with atrial fibrillation ( AF ) are not candidates for rhythm control and may require rate control, typically with beta‐blocking ( BB ) or calcium channel blocking ( CCB ) agents. Although these patients appear to have a low 30‐day rate of stroke or death, it is unclear if one class of agent is safer or more effective. The objective was to determine whether BB s or CCB s would have a lower hospital admission rate and to measure 30‐day safety outcomes including stroke, death, and emergency department (ED) revisits. Methods This retrospective cohort study used a database from two urban EDs to identify consecutive patients with ED discharge diagnoses of AF from April 1, 2006, to March 31, 2010. Comorbidities, rhythms, management, and immediate outcomes were obtained by manual chart review, and patients with acute underlying medical conditions were excluded by predefined criteria. Patients managed only with rate control agents were eligible for review, and patients receiving BB agents were compared to those receiving CCB agents. The primary outcome was the proportion of patients requiring hospital admission; secondary outcomes included the ED length of stay ( LOS ), the proportion of patients having adverse events, the proportion of patients returning within 7 or 30 days, and the number of patients having a stroke or dying within 30 days. Results A total of 259 consecutive patients were enrolled, with 100 receiving CCB s and 159 receiving BB s. Baseline demographics and comorbidities were similar. Twenty‐seven percent of BB patients were admitted, and 31.0% of CCB patients were admitted (difference = 4.0%, 95% confidence interval [ CI ] = −7.7% to 16.1%), and there were no significant differences in ED LOS , adverse events, or 7‐ or 30‐day ED revisits. One patient who received metoprolol had a stroke, and one patient who received diltiazem died within 30 days. Conclusions In this cohort of ED patients with AF and no acute underlying medical illness who underwent rate control only, patients receiving CCB s had similar hospital admission rates to those receiving BB s, while both classes of medications appeared equally safe at 30 days. Both CCB s and BB s are acceptable options for rate control.