University of Liverpool and The Royal Liverpool and Broadgreen University Hospitals, Liverpool Health Partners, Liverpool, UK.
Wellcome-Wolfson Institute of Experimental Medicine, Queen's University Belfast, Belfast, UK.
Syst Rev. 2019 Oct 28;8(1):242. doi: 10.1186/s13643-019-1149-7.
New onset atrial fibrillation is the most commonly encountered arrhythmia in critically unwell patients with a reported incidence of 4% to 29%. The occurrence of new onset atrial fibrillation may precipitate acute heart failure and lead to thromboembolic complications as well as being associated with increased in-hospital and in intensive care unit (ICU) mortality. Despite being common, much of our current knowledge regarding the treatment of new onset atrial fibrillation comes from patients with chronic atrial fibrillation or post cardiac surgery. It is unclear if management strategies in these patient cohorts can be applied to new onset atrial fibrillation in the general ICU. This protocol for a systematic review and network meta-analysis aims to address this uncertainty and define what is the most effective management strategy for the treatment of new onset atrial fibrillation (NOAF) in acutely unwell adult patients.
In this systematic review and network meta-analysis, we plan to search electronic databases (Cochrane Central Register of Controlled Trials [CENTRAL], MEDLINE, EMBASE, Science Citation Index Expanded on Web of Science and relevant trial registries) for relevant randomised and non-randomised trials. Citations will be reviewed by title, abstract and full text by two independent reviewers and disagreement resolved by discussion and a third independent reviewer, if necessary. The Cochrane Risk of Bias tool will be used to assess risk of bias in randomised trials and the Risk of Bias in Nonrandomised Studies of Interventions (ROBINS-I) tool will be used for non-randomised studies. Statistical analysis will be carried out using R package meta and netmeta. We will first conduct a pairwise meta-analysis. If conditions for indirect comparison are satisfied and suitable data are available, we will conduct network meta-analysis using frequentist methodology. Treatments will be ranked according to efficacy with associated P-scores. We will assess the quality of the evidence in the pairwise using GRADE methodology and network meta-analysis comparisons in the CINeMA module in R package meta.
Our review will be the first to assess direct and indirect evidence to assess the efficacy and rank the treatments available for new onset atrial fibrillation in critically unwell patients. Our review findings will be applicable to the care of people in a range of acute settings including, ICU, the emergency department and acute medical units.
PROSPERO registry number: CRD42019121739.
新发心房颤动是危重症患者最常见的心律失常，发病率为 4%至 29%。新发心房颤动的发生可能会引发急性心力衰竭，并导致血栓栓塞并发症，同时与住院和重症监护病房（ICU）死亡率增加有关。尽管很常见，但我们目前关于新发心房颤动治疗的大部分知识来自于慢性心房颤动或心脏手术后的患者。这些患者群体中的管理策略是否可以应用于一般 ICU 中的新发心房颤动尚不清楚。本系统评价和网络荟萃分析的方案旨在解决这一不确定性，并确定治疗急性危重症成年患者新发心房颤动（NOAF）最有效的管理策略。
在本系统评价和网络荟萃分析中，我们计划在电子数据库（Cochrane 对照试验中心注册库[CENTRAL]、MEDLINE、EMBASE、科学引文索引扩展版在 Web of Science 和相关试验注册库）中搜索相关的随机和非随机试验。由两名独立审查员根据标题、摘要和全文进行审查，如果有必要，将通过讨论和第三名独立审查员解决意见分歧。将使用 Cochrane 偏倚风险工具评估随机试验的偏倚风险，并用非随机干预研究的偏倚风险（ROBINS-I）工具评估非随机研究。统计分析将使用 R 包 meta 和 netmeta 进行。我们将首先进行成对荟萃分析。如果满足间接比较条件且有合适的数据，我们将使用似然法进行网络荟萃分析。将根据疗效对治疗方法进行排名，并附有相关 P 分。我们将使用 GRADE 方法对成对比较中的证据质量进行评估，并在 R 包 meta 中的 CINeMA 模块中对网络荟萃分析比较进行评估。
我们的综述将是第一个评估直接和间接证据以评估治疗危重症新发心房颤动的疗效和对现有治疗方法进行排名的综述。我们的综述结果将适用于一系列急性治疗环境中的人群，包括 ICU、急诊科和急性医学病房。
PROSPERO 注册号：CRD42019121739。
