Diltiazem initiation was associated with a lower probability of achieving a heart rate <110 beats/min within 1 hour compared to metoprolol (OR 0.67) in ICU patients with atrial fibrillation.
Observational (n=1,492)
No
Does intravenous diltiazem initiation improve early rate control compared to metoprolol in ICU patients with atrial fibrillation with rapid ventricular rate?
In ICU patients with atrial fibrillation and rapid ventricular rate, metoprolol initiation was associated with a higher probability of early rate control and a lower probability of requiring additional short-term medications compared to diltiazem.
Odds Ratio: 0.67 (95% CI 0.51–0.88)
Absolute Event Rate: 40.8% vs 53%
p-value: p=0.011
Atrial fibrillation with rapid ventricular rate is common and difficult to manage. The evidence for the effectiveness of intravenous rate-controlling drugs is limited. In this study, MIMIC-IV was used to simulate the target trial, comparing “diltiazem initiation” with “metoprolol initiation”: patients were enrolled with the first administration as T0, excluding those with concurrent initial medications, missing baseline heart rate, non-rapid ventricular rate, and insufficient observation window; missing data were imputed, and propensity score weighting was used to balance covariates. The primary outcome was achievement of heart rate < 110 beats/min within the first hour after T0; the secondary outcomes were recorded additional AF-related medication within 6 h after T0, in-hospital death, and ICU stay days. A total of 1492 cases were included (321 cases of diltiazem and 1171 cases of metoprolol), and the absolute SMD after weighting was close to 0. Diltiazem initiation was associated with a lower probability of achieving the primary outcome (OR = 0.67, 95% CI 0.51–0.88) and a higher probability of requiring additional medication within 6 h (OR = 2. 63, 95% CI 1. 98–3. 49); there was no significant difference in in-hospital death (OR = 0. 88, 95% CI 0. 66–1. 17) and ICU stay days (MD = −0. 41 days, 95% CI −1. 42 to 0. 61). The subgroup directions were consistent, and the interaction P for mechanical ventilation was 0. 057. Overall, metoprolol initiation was associated with a higher probability of early rate control and a lower probability of short-term additional AF-related medication in the overlap population, although these findings should be interpreted as hypothesis-generating because of residual confounding and limitations of structured electronic health-record data.
Deng et al. (Fri,) conducted a observational in Atrial fibrillation with rapid ventricular rate (n=1,492). Diltiazem vs. Metoprolol was evaluated on Achievement of heart rate <110 beats/min within the first hour after T0 (OR 0.67, 95% CI 0.51-0.88, p=0.011). Diltiazem initiation was associated with a lower probability of achieving a heart rate <110 beats/min within 1 hour compared to metoprolol (OR 0.67) in ICU patients with atrial fibrillation.