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Management of acute atrial fibrillation in the intensive care unit: An international survey
M. Wetterslev, MH. Møller, A. Granholm, C. Hassager, N. Haase, TN. Aslam, J. Shen, PJ. Young, A. Aneman, J. Hästbacka, M. Siegemund, M. Cronhjort, E. Lindqvist, SN. Myatra, K. Kalvit, YM. Arabi, W. Szczeklik, MI. Sigurdsson, M. Balik, F. Keus, A....
Jazyk angličtina Země Velká Británie
Typ dokumentu časopisecké články
Grantová podpora
Ehrenreichs Foun
dation
Danish Society of Anaesthesiology and Intensive Care Medicine (DASAIM)
Research Council of Rigshospitalet
PubMed
34870855
DOI
10.1111/aas.14007
Knihovny.cz E-zdroje
- MeSH
- antiarytmika terapeutické užití MeSH
- fibrilace síní * farmakoterapie MeSH
- jednotky intenzivní péče MeSH
- lidé MeSH
- průzkumy a dotazníky MeSH
- sotalol terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
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: 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: 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: 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.
Department of Cardiology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
Department of Critical Care Medicine Peking University People's Hospital Beijing China
Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
Faculty of Medicine University of Iceland Reykjavik Iceland
Intensive Care Programme Director Medical Research Institute of New Zealand Wellington New Zealand
Citace poskytuje Crossref.org
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- $a 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: 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: 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: 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.
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