Evidence map›Paper›PMID 25441768›Full record

ArticleAnnals of emergency medicine2015

Emergency Department Patients With Atrial Fibrillation or Flutter and an Acute Underlying Medical Illness May Not Benefit From Attempts to Control Rate or Rhythm.

Frank X Scheuermeyer, Reza Pourvali, Brian H Rowe, Eric Grafstein, Claire Heslop, Jan MacPhee, Lorraine McGrath, John Ward, Brett Heilbron, Jim Christenson

Abstract readEvaluation StudyVideo-Audio Media
PubMed Publisher
In one paragraph

Article in Annals of emergency medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
2.4field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it, 43 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 3 institutions in 1 country.

Frank X ScheuermeyerDepartment of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: frank.scheuermeyer@gmail.com.
Reza PourvaliDepartment of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada.
Brian H RoweDepartment of Emergency Medicine, University of Alberta Hospital and the University of Alberta, Edmonton, Alberta, Canada.
Eric GrafsteinDepartment of Emergency Medicine, Mount St Joseph's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada.
Claire HeslopDepartment of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada.
Jan MacPheeDepartment of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada.
Lorraine McGrathDivision of Cardiology, Department of Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada.
John WardDepartment of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada; Division of Hematology, Department of Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada.
Brett HeilbronDivision of Cardiology, Department of Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada.
Jim ChristensonDepartment of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada.
University of British Columbia · CASt. Paul's Hospital · CASt. Joseph's Hospital · CA

Funding

Canadian Institutes of Health Research
6 · The paper itself

Abstract

STUDY

objectiveAlthough the management and outcomes of emergency department (ED) patients with atrial fibrillation or flutter have been explored, such studies have typically excluded patients with acute underlying medical illnesses. We seek to describe the ED treatment and outcomes of these complex patients with atrial fibrillation or flutter.

methodsThis retrospective descriptive cohort study used an ECG database from 2 urban EDs to identify consecutive ED patients with an ECG demonstrating atrial fibrillation or flutter from January 1, 2009, to December 31, 2009. We categorized patients with atrial fibrillation or flutter as "complex" according to prespecified criteria and then grouped them as being managed with rate or rhythm control attempts, or not. The primary outcome was safety of rate or rhythm control, measured by whether patients had a predefined adverse event or not. The secondary outcome was the success of rate or rhythm control, defined as rate control decreasing the pulse rate by 20 beats/min and successful rhythm control, both within 4 hours of treatment initiation. Descriptive statistics were used to compare the 2 groups.

resultsFour hundred sixteen complex patients with atrial fibrillation or flutter were identified. Patients managed with rate or rhythm control were similar in all baseline characteristics and illness distribution to patients who were not managed in this manner. The 135 patients with attempted rate control (105) or rhythm control (30) had 55 adverse events (40.7%; 95% confidence interval [CI] 32.5% to 49.5%), whereas the 281 patients not managed with rate or rhythm control had 20 adverse events (7.1%; 95% CI 4.5% to 10.9%), for a risk difference of 33.6% (95% CI 24.3% to 42.5%) and a relative risk of 5.7 (95% CI 3.6 to 9.1). Twenty of 105 patients (19.1%; 95% CI 12.3% to 28.1%) were successfully rate controlled, whereas 4 of 30 (13.3%; 95% CI 4.4% to 31.6%) were successfully rhythm controlled.

conclusionIn ED patients with complex atrial fibrillation or flutter, attempts at rate and rhythm control are associated with a nearly 6-fold higher adverse event rate than that for patients who are not managed with rate or rhythm control. Success rates of rate or rhythm control attempts appear low.

Indexed as

Emergency Service, HospitalAcute DiseaseAdultAgedAged, 80 and overAnti-Arrhythmia AgentsAtrial FibrillationAtrial FlutterCohort StudiesFemaleHumansLogistic ModelsMaleMiddle AgedRetrospective StudiesTreatment OutcomeAnti-Arrhythmia Agents

Identifiers

PMID25441768
OpenAlexW2125393405

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.