Antiarrhythmic drug therapy among patients presenting to emergency department with symptomatic atrial fibrillation - a prospective nationwide cohort

Tero Penttilä, Heikki Mäkynen, Juha Hartikainen, Harri Hyppölä, Timo Lauri, Mika Lehto, Juha Lund, M J Pekka Raatikainen, FinFib2 investigators, Pekka Raatikainen, Mika Lehto, Aleksi Almenoksa, Juha Koskinen, Sergei Kesonen, Jyri Veräjänkorva, Kimmo Salmio, Juhani Metsäniitty, Laura Mikkonen, Jouni Nurmi, Risto Viitanen, Jukka Vaahersalo, Jukka Rinne, Risto Pajari, Jani Mononen, Anna-Mari Hekkala, Laura Moring, Bernd Günther, Juha Lund, Jarkko Karihuhta, Jon Holmström, Juho Lindberg, Anja Toljamo, Jonna Juhola, Marjatta Strandberg, Tuula Meinander, Heikki Mäkynen, Tero Penttilä, Ville Hällberg, Tapio Innamaa, Hanna Suurmunne, Jari Nyrhilä, Katja Jokela, Peeter Kasemets, Juha Hartikainen, Matti Onnela, Harri Hyppölä, Kai Nyman, Pirjo Mustonen, Tuomas Rissanen, Jaana Luukkonen, Pertti Salmi, Pekka Salminen, Teemu Lasanen, Matti Kettunen, Timo Lauri, Ari Toppinen, Jussi Sia, Hanna Tormilainen, Magnus Hagnäs, Tapio Åman, Liisa Miettinen, Niilo Keränen, Tero Penttilä, Heikki Mäkynen, Juha Hartikainen, Harri Hyppölä, Timo Lauri, Mika Lehto, Juha Lund, M J Pekka Raatikainen, FinFib2 investigators, Pekka Raatikainen, Mika Lehto, Aleksi Almenoksa, Juha Koskinen, Sergei Kesonen, Jyri Veräjänkorva, Kimmo Salmio, Juhani Metsäniitty, Laura Mikkonen, Jouni Nurmi, Risto Viitanen, Jukka Vaahersalo, Jukka Rinne, Risto Pajari, Jani Mononen, Anna-Mari Hekkala, Laura Moring, Bernd Günther, Juha Lund, Jarkko Karihuhta, Jon Holmström, Juho Lindberg, Anja Toljamo, Jonna Juhola, Marjatta Strandberg, Tuula Meinander, Heikki Mäkynen, Tero Penttilä, Ville Hällberg, Tapio Innamaa, Hanna Suurmunne, Jari Nyrhilä, Katja Jokela, Peeter Kasemets, Juha Hartikainen, Matti Onnela, Harri Hyppölä, Kai Nyman, Pirjo Mustonen, Tuomas Rissanen, Jaana Luukkonen, Pertti Salmi, Pekka Salminen, Teemu Lasanen, Matti Kettunen, Timo Lauri, Ari Toppinen, Jussi Sia, Hanna Tormilainen, Magnus Hagnäs, Tapio Åman, Liisa Miettinen, Niilo Keränen

Abstract

Background: Atrial fibrillation (AF) is a common arrhythmia that causes numerous visits to emergency departments (ED). The aim of the FinFib2 study was to evaluate whether treatment of patients with AF in ED is consistent with the contemporary European Society of Cardiology (ESC) management guidelines. Here we report the results of antiarrhythmic drug therapy (AAD) in ED.

Methods: All patients within the two-week study period whose primary reason for the ED visit was symptomatic AF were included into this prospective multicentre study. Comprehensive data on factors contributing to the treatment of AF were collected, including a data of previous use of ADDs, and changes made for them during a visit in ED.

Results: The study population consisted of 1013 consecutive patients (mean age 70 ± 13 years, 47.6% female). The mean European Heart Rhythm Association (EHRA) symptom score was 2.2 ± 0.8. Rhythm control strategy was opt for 498 (63.8%) and 140 (64.5%) patients with previously and newly diagnosed AF, respectively. In patients with previously diagnosed AF the most frequently used AAD was a beta blocker (80.9%). Prior use of class I (11.4%) and III (9.1%) AADs as well as start or adjustment of their dosage (7.4%) were uncommon. Most of the patients with newly diagnosed AF were prescribed a beta blocker (71.0%) or a calcium channel antagonist (24.0%), and only two of them received class I or class III AADs.

Conclusions: Our data demonstrated that in patients presenting to the ED with recurrent symptomatic AF and aimed for rhythm control strategy, the use of class I and class III AADs was rare despite ESC guideline recommendations. It is possible that early adaptation of a more aggressive rhythm control strategy might improve a quality of life for symptomatic patients and alleviate the ED burden associated with AF. Beta blockers were used by majority of patients as rate control therapy both in rate and rhythm control groups.

Trial registration: NCT01990105 . Registered 15 November 2013.

Keywords: Antiarrhythmic medication; Atrial fibrillation; EHRA score; Emergency department; Rate control; Rhythm control.

Conflict of interest statement

Ethics approval and consent to participate

The study protocol was approved by the Pirkanmaa Hospital District Ethical Committee (R13044). According to Ethical Committee, individual approval from patients participating was not needed.

Consent for publication

Not applicable.

Competing interests

TP and PR have received research grants from the Finnish Cardiac Society (FCS). All other authors declare that there is no conflict of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Classification of AF related symptoms according to the European Heart Rhythm Association (EHRA) score in patients with prior (n = 780) and newly diagnosed AF (n = 217) (a) and in patients with rhythm control (n = 659) and rate control strategy (n = 336) (b). EHRA 1 = no symptoms, EHRA 2 = mild symptoms (normal daily activity not affected), EHRA 3 = severe symptoms (normal daily activity affected), EHRA IV = disabling symptoms (normal daily activity discontinued)
Fig. 2
Fig. 2
The use of antiarrhythmic drugs among patients with previously diagnosed AF (n = 780) at admission to the ED (black column) and at discharge (light grey column)

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