A comparison of diltiazem versus metoprolol for patients with atrial fibrillation presenting to the emergency department with rapid ventricular rate

JAPhA Practice Innovations Pub Date : 2025-07-01 DOI:10.1016/j.japhpi.2025.100029

Brittany McCoy, Jason Arevalo, Ashley Oliver, Katelyn Corcoran, Christopher R. Frei

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Abstract

Background

Atrial fibrillation (AF) is one of the most common cardiac dysrhythmias and one of the most commonly encountered dysrhythmias in emergency departments (EDs). Rate control is vital to relieve symptoms and prevent complications in patients who present with AF and a rapid ventricular rate (RVR), defined as a heart rate (HR) > 120 beats per minute (bpm). Both metoprolol and diltiazem are recommended for the management of RVR in AF; however, the comparative effectiveness of these medications is unclear.

Objectives

The primary objective of this quality improvement project was to evaluate the achievement of rate control, defined as a HR < 110 bpm or an HR reduction > 20%, within 30 minutes of the first dose of IV diltiazem or metoprolol. The secondary objectives were rate control within 60 minutes of the first dose, rate control within 180 minutes of the first dose, occurrence of repeat dosing, additional medications required for rate control, worsening heart failure (HF) symptoms, admission and discharge diagnoses, hospital readmission within 7 days of discharge, and length of hospital stay. We also assessed the incidence of hypotensive and bradycardic events within 60 minutes of the first dose.

Methods

A total of 571 patient charts were screened for inclusion in this quality improvement project and 151 patients were included.

Results

In a multivariate logistic regression model, with controls for patient age, rate control within 180 minutes of the first dose, and repeat dosing of medication given, there was no statistically significant difference in the primary outcome of rate control within 30 minutes between IV diltiazem (77%) and metoprolol (65%) (odds ratio 0.56 [95% CI 0.22-1.39], P = 0.27). We also found no statistically significant differences in the multivariate models for the incidence of worsening HF, hypotension, or bradycardia. Minimal adverse effects were observed.

Conclusions

The results of this study expand upon previous literature that suggested that diltiazem is likely to be safe and effective in the acute management of AF with RVR, given that there was no statistically significant difference between the 2 study drugs in the achievement of rate control or documentation of worsening HF.

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地尔硫卓与美托洛尔治疗急诊科室性心律失常患者的比较

房颤（AF）是最常见的心律失常之一，也是急诊科（ed）最常见的心律失常之一。心率控制对于房颤和快速心室率（RVR）患者缓解症状和预防并发症至关重要，RVR定义为心率（HR） >；每分钟120次。美托洛尔和地尔硫卓均被推荐用于房颤的RVR治疗；然而，这些药物的相对有效性尚不清楚。本质量改进项目的主要目标是评价率控制的实现情况，定义为HR <；每分钟110次或人力资源减少>；20%，第一次静脉注射地尔硫卓或美托洛尔后30分钟内。次要目标是首次给药后60分钟内的速率控制、首次给药后180分钟内的速率控制、重复给药的发生、速率控制所需的额外药物、心力衰竭（HF）症状恶化、入院和出院诊断、出院后7天内的再入院以及住院时间。我们还评估了首次给药后60分钟内低血压和心动过缓事件的发生率。方法共筛选571份患者病历纳入本质量改进项目，其中151例患者入选。结果在多因素logistic回归模型中，以患者年龄、首次给药后180分钟内的率控制率和重复给药为对照，静脉滴注地尔硫卓（77%）和美托洛尔（65%）在30分钟内的率控制率的主要结局差异无统计学意义（优势比0.56 [95% CI 0.22-1.39], P = 0.27）。我们还发现，在心衰加重、低血压或心动过缓发生率的多变量模型中，没有统计学上的显著差异。观察到最小的不良反应。结论：本研究的结果扩展了先前的文献，认为地尔硫卓在急性房颤合并RVR的治疗中可能是安全有效的，因为两种研究药物在实现发病率控制或记录心衰恶化方面没有统计学上的显著差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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JAPhA Practice Innovations

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