Schmitt Cassandra J, Mattson Alicia E, Cabrera Daniel, Mullan Aidan, Marí Chantada Coral, Howick Annelise S, Kane Garvan C, Bellolio Fernanda
Department of Pharmacy, Mayo Clinic, Rochester, Minnesota.
Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota.
J Emerg Med. 2024 Dec;67(6):e560-e568. doi: 10.1016/j.jemermed.2024.06.010. Epub 2024 Jun 13.
Diltiazem is an effective rate control agent for atrial fibrillation with rapid ventricular rate (AF RVR). However, its negative inotropic effects may increase the risk for worsening heart failure in patients with a reduced ejection fraction (EF).
This observational study aims to describe the incidence of worsening heart failure in patients who receive intravenous diltiazem for acute atrial fibrillation management.
Adult patients that received diltiazem in the emergency department (ED) for AF RVR (heart rate ≥ 100 beats/min) from 2021 to 2022 and had a prior documented EF were included. The primary outcome is worsening heart failure within 24 h of diltiazem administration. Secondary outcomes include return ED visits and death within 7 days. EF percentage was compared across outcomes using Wilcoxon rank-sum tests. Outcomes were compared by reduced EF (< 50%) and preserved EF (≥ 50%). Continuous data were summarized with medians and interquartile ranges, and categorical features were summarized with frequency counts and percentages. Wilcoxon rank-sum tests were used for numeric outcomes and chi-squared tests or Fisher's exact tests for categorical outcomes, with a p-value < 0.05 considered statistically significant.
There were 674 patients with AF RVR that received diltiazem, and 386 patients met the inclusion criteria for analysis. Baseline demographics included a median age of 72 (64-81) years, with 14.5% of patients having a prior diagnosis of congestive heart failure. EF < 50% was identified in 13.7% of patients (n = 53), of which approximately 30% of these patients safely discharged home after receiving i.v. diltiazem. The primary outcome of worsening heart failure occurred in 7/41 (17%) and 10/207 (4.8%) patients with reduced and preserved ejection fractions, respectively, who were admitted to the hospital (p = 0.005).
The development of worsening heart failure is multifactorial and may include the use of diltiazem in critically ill patients requiring hospital admission.
地尔硫䓬是控制房颤伴快速心室率（AF RVR）的有效药物。然而，其负性肌力作用可能会增加射血分数降低（EF）患者发生心力衰竭恶化的风险。
本观察性研究旨在描述接受静脉用地尔硫䓬治疗急性房颤患者中发生心力衰竭恶化的发生率。
纳入2021年至2022年在急诊科（ED）因AF RVR（心率≥100次/分钟）接受地尔硫䓬治疗且既往有记录EF的成年患者。主要结局是地尔硫䓬给药后24小时内心力衰竭恶化。次要结局包括7天内再次急诊就诊和死亡。使用Wilcoxon秩和检验比较不同结局的EF百分比。根据降低的EF（<50%）和保留的EF（≥50%）比较结局。连续数据用中位数和四分位数间距汇总，分类特征用频数和百分比汇总。数值结局采用Wilcoxon秩和检验，分类结局采用卡方检验或Fisher精确检验，p值<0.05认为具有统计学意义。
674例AF RVR患者接受了地尔硫䓬治疗，386例患者符合纳入分析标准。基线人口统计学特征包括年龄中位数为72（64 - 81）岁，14.5%的患者既往诊断为充血性心力衰竭。13.7%的患者（n = 53）EF<50%，其中约30%的这些患者在接受静脉用地尔硫䓬治疗后安全出院回家。分别有7/41（17%）和10/207（4.8%）射血分数降低和保留的住院患者发生心力衰竭恶化这一主要结局（p = 0.005）。
心力衰竭恶化的发生是多因素的，可能包括在需要住院的重症患者中使用地尔硫䓬。
