Management of acute atrial fibrillation in the intensive care unit: An international survey.
anticoagulant therapy
atrial fibrillation
intensive care unit
management strategies
Journal
Acta anaesthesiologica Scandinavica
ISSN: 1399-6576
Titre abrégé: Acta Anaesthesiol Scand
Pays: England
ID NLM: 0370270
Informations de publication
Date de publication:
Mar 2022
Mar 2022
Historique:
revised:
11
11
2021
received:
07
10
2021
accepted:
30
11
2021
pubmed:
7
12
2021
medline:
12
3
2022
entrez:
6
12
2021
Statut:
ppublish
Résumé
Atrial fibrillation (AF) is common in intensive care unit (ICU) patients and is associated with poor outcomes. Different management strategies exist, but the evidence is limited and derived from non-ICU patients. This international survey of ICU doctors evaluated the preferred management of acute AF in ICU patients. We conducted an international online survey of ICU doctors with 27 questions about the preferred management of acute AF in the ICU, including antiarrhythmic therapy in hemodynamically stable and unstable patients and use of anticoagulant therapy. A total of 910 respondents from 70 ICUs in 14 countries participated in the survey with 24%-100% of doctors from sites responding. Most ICUs (80%) did not have a local guideline for the management of acute AF. The preferred first-line strategy for the management of hemodynamically stable patients with acute AF was observation (95% of respondents), rhythm control (3%), or rate control (2%). For hemodynamically unstable patients, the preferred strategy was observation (48%), rhythm control (48%), or rate control (4%). Overall, preferred antiarrhythmic interventions included amiodarone, direct current cardioversion, beta-blockers other than sotalol, and magnesium in that order. A total of 67% preferred using anticoagulant therapy in ICU patients with AF, among whom 61% preferred therapeutic dose anticoagulants and 39% prophylactic dose anticoagulants. This international survey indicated considerable practice variation among ICU doctors in the clinical management of acute AF, including the overall management strategies and the use of antiarrhythmic interventions and anticoagulants.
Sections du résumé
BACKGROUND
BACKGROUND
Atrial fibrillation (AF) is common in intensive care unit (ICU) patients and is associated with poor outcomes. Different management strategies exist, but the evidence is limited and derived from non-ICU patients. This international survey of ICU doctors evaluated the preferred management of acute AF in ICU patients.
METHOD
METHODS
We conducted an international online survey of ICU doctors with 27 questions about the preferred management of acute AF in the ICU, including antiarrhythmic therapy in hemodynamically stable and unstable patients and use of anticoagulant therapy.
RESULTS
RESULTS
A total of 910 respondents from 70 ICUs in 14 countries participated in the survey with 24%-100% of doctors from sites responding. Most ICUs (80%) did not have a local guideline for the management of acute AF. The preferred first-line strategy for the management of hemodynamically stable patients with acute AF was observation (95% of respondents), rhythm control (3%), or rate control (2%). For hemodynamically unstable patients, the preferred strategy was observation (48%), rhythm control (48%), or rate control (4%). Overall, preferred antiarrhythmic interventions included amiodarone, direct current cardioversion, beta-blockers other than sotalol, and magnesium in that order. A total of 67% preferred using anticoagulant therapy in ICU patients with AF, among whom 61% preferred therapeutic dose anticoagulants and 39% prophylactic dose anticoagulants.
CONCLUSION
CONCLUSIONS
This international survey indicated considerable practice variation among ICU doctors in the clinical management of acute AF, including the overall management strategies and the use of antiarrhythmic interventions and anticoagulants.
Substances chimiques
Anti-Arrhythmia Agents
0
Sotalol
A6D97U294I
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
375-385Subventions
Organisme : Ehrenreichs Foun
Organisme : dation
Organisme : Danish Society of Anaesthesiology and Intensive Care Medicine (DASAIM)
Organisme : Research Council of Rigshospitalet
Investigateurs
Bin Huang
(B)
Miao Yan
(M)
Wei Liu
(W)
Yanjiu Deng
(Y)
Lei Zhang
(L)
Pavel Suk
(P)
Kasper Mørk Sørensen
(K)
Anne Sofie Andreasen
(AS)
Morten H Bestle
(MH)
Mette Krag
(M)
Lone M Poulsen
(LM)
Thomas Hildebrandt
(T)
Kirsten Møller
(K)
Hasse Møller-Sørensen
(H)
Jeppe Bove
(J)
Toke A Kilsgaard
(TA)
Idrees Ahmad Salam
(IA)
Anne Craveiro Brøchner
(AC)
Thomas Strøm
(T)
Christoffer Sølling
(C)
Line Kolstrup
(L)
Mariusz Boczan
(M)
Bodil S Rasmussen
(BS)
Iben S Darfelt
(IS)
Ville Jalkanen
(V)
Pasi Lehto
(P)
Matti Reinikainen
(M)
Sigurbergur Kárason
(S)
Kristinn Sigvaldason
(K)
Oddur Olafsson
(O)
Sara Vergis
(S)
Joanne Mascarenhas
(J)
Mehul Shah
(M)
Sai Praveen Haranath
(SP)
Andrew Van Der Poll
(A)
Stig Gjerde
(S)
Ole Kristian Fossum
(OK)
Kristian Strand
(K)
Helge L Wangberg
(HL)
Emil Berta
(E)
Stephan Balsliemke
(S)
Andrew C Robertson
(AC)
Robert Pedersen
(R)
Vegard Dokka
(V)
Pascal Brügger-Synnes
(P)
Tomasz Czarnik
(T)
Alia A Albshabshe
(AA)
Ghaleb Almekhlafi
(G)
Agnes Knight
(A)
Emily Tegnell
(E)
Fredrik Sjövall
(F)
Stephan Jakob
(S)
Miodrag Filipovic
(M)
Gian-Reto Kleger
(GR)
Ruben J Eck
(RJ)
Informations de copyright
© 2021 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
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