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  • Beta-blockers or...

Beta-blockers or amiodarone more effective than CCBs in AF patients in ICU: Study

Written By : Dr. Shravani Dali |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2021-07-27T09:00:33+05:30  |  Updated On 19 Oct 2023 12:14 PM IST
Beta-blockers or amiodarone more effective than CCBs in AF patients in ICU: Study
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Beta-blockers or amiodarone may be more beneficial as compared to the calcium channel blockers (CCBs) as first-line therapy in undifferentiated patients; but more evidence is needed for their usage in patients with new-onset atrial fibrillation admitted in the ICU, suggests a study published in the Critical Care.

New-onset atrial fibrillation (NOAF) is usually managed by admitting the patients to an intensive care unit (ICU). However, it is generally associated with increased morbidity and mortality.

A systematic scoping review was undertaken by a group of researchers from the United Kingdom to summarise comparative evidence to inform new-onset atrial fibrillation management for patients admitted to ICU.

The researchers searched various databases like MEDLINE, EMBASE, CINAHL, Web of Science, OpenGrey, Cochrane Database of Systematic, EU Clinical Trials register, additional WHO ICTRP trial databases, and NIHR Clinical Trials Gateway, etc. in March 2019.From which they included studies assessing treatment or prevention strategies for new-onset atrial fibrillation management (NOAF) or acute anticoagulation in general medical, surgical or mixed adult ICUs.They collected all the study details, population demographics, intervention and comparator(s), methods addressing confounding, results, and recommendations for future research onto study-specific forms. Finally, out of 3,651 total citations, only 42 articles were eligible. Out of which 25 were primary studies, 12 were review articles and 5 were surveys/opinion papers. Definitions of NOAF varied from NOAF lasting 30 seconds to NOAF lasting greater than 24 hours. Only one comparative study investigated the effects of anticoagulation.

The findings of the study are as follows:

· Proof from small randomized control trials suggest that calcium channel blockers (CCBs) are slower than beta-blockers in rhythm control (1 study), and also cause more cardiovascular instability as compared to amiodarone (1 study).

· While proof from 4 non-randomized studies suggest that beta-blocker and amiodarone therapy may work in a similar fashion concerning rhythm control.

· Beta-blockers may be also tied with reduced mortality as compared to amiodarone, Calcium channel blockers (CCBs), and digoxin, though supporting evidence is subject to confounding.

· Currently, the limited data does not support therapeutic anticoagulation during ICU admission.

The researchers conclude that though the evidence available suggests that beta-blockers or amiodarone may be superior to calcium channel blockers (CCBs) as a primary treatment protocol in undifferentiated patients in ICU; there is not much evidence available to support the use of therapeutic anticoagulation for NOAF in critically ill patients. So, consensus definitions for NOAF, rate, and rhythm control are needed.

Reference:

Treatment strategies for new-onset atrial fibrillation in patients treated on an intensive care unit: a systematic scoping review by Drikite L et. al published in the Critical Care.

https://ccforum.biomedcentral.com/articles/10.1186/s13054-021-03684-5


icuanticoagulantatrial fibrillationnoafnew onset atrial fibrillationpatientscritcally illbeta-blockersamiodaronecalcium channel blockersccbcritical care
Source : Critical Care
Dr. Shravani Dali
Dr. Shravani Dali

    Dr. Shravani Dali has completed her BDS from Pravara institute of medical sciences, loni. Following which she extensively worked in the healthcare sector for 2+ years. She has been actively involved in writing blogs in field of health and wellness. Currently she is pursuing her Masters of public health-health administration from Tata institute of social sciences. She can be contacted at editorial@medicaldialogues.in.

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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