Diltiazem vs. Metoprolol in the Acute Management of AF in Patients With HFrEF

• Status: Completed
• Trial end date: 2017-03-01
• Target enrollment: 0
• Participant gender: All

Summary

Atrial fibrillation (AF) is the most common arrhythmia, accounting for one third of all hospital admissions and 1% of all emergency department visits (ED). Approximately 65% of those presenting to the ED with AF are admitted. There are also numerous reasons for patients to get AF with rapid ventricular rate (AF RVR) during hospitalization. In the acute setting these patients are often treated with diltiazem, a non-dihydropyridine calcium channel blocker (ND CCB), or metoprolol, a beta blocker (BB). Non-dihydropyridine calcium channel blocker (diltiazem and verapamil) use is considered harmful and national guidelines recommend against use in patients with decompensated heart failure (HF). This recommendation is based on studies with long-term treatment. The purpose of this study is to assess the difference between metoprolol and diltiazem for the acute treatment of AF RVR in patients with HF with reduced ejection fraction (HFrEF).

Details

• Lead Sponsor: RaeAnn Hirschy
• Collaborators: Gary Peksa, PharmD, BCPS; Joshua DeMott, PharmD, BCPS, BCCCP; Kimberly Ackerbauer, PharmD, BCPS, BCCCP; Paul O'Donnell, PharmD, BCPS, BCCCP
• Treatments: Diltiazem; Metoprolol

Criteria

Inclusion Criteria:

• Non-pregnant adults ≥18 years of age with AF RVR (HR >120 bpm), which will be obtained from vital signs or electrocardiogram, in the emergency department, who have an EF <40% from an echocardiogram within the previous 4 years, and are treated with IV push metoprolol or diltiazem as first line for rate control of AF with RVR. Patients can receive up to two IV push doses but cannot switch treatment medication between these two doses.

Exclusion Criteria:

• Patients with a SBP <90 mmHg or decompensated heart failure (ie those presenting primarily with worsening of heart failure signs and symptoms, including dyspnea and lower extremity edema). Patients who are admitted multiple times within the time frame or have multiple episodes will be excluded except for the first episode within the first admission.