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The following is a summary of “Safety of Diltiazem for Acute Management of Atrial Fibrillation (AF) in Patients with Heart Failure and Reduced Ejection Fraction in the Emergency Department,” published in the December 2024 issue of Emergency Medicine by Schmitt et al.
Diltiazem effectively controls heart rate in atrial fibrillation with rapid ventricular rate (AF RVR) but might worsen heart failure due to its adverse inotropic effects in individuals with reduced ejection fraction (EF).
Researchers conducted a retrospective study to define the incidence of worsening heart failure in individuals who received intravenous diltiazem for acute atrial fibrillation management.
They included adults treated with diltiazem in the emergency department (ED) for AF RVR (heart rate ≥ 100 beats/min) between 2021 and 2022, with prior documented EF. The primary outcome was worsening heart failure within 24 hours of diltiazem use, while secondary outcomes included return ED visits and death within 7 days. The EF percentages were analyzed across outcomes using Wilcoxon rank-sum tests, comparing reduced EF (< 50%) and preserved EF (≥ 50%). Continuous data were reported as medians with interquartile ranges and categorical data as counts and percentages. Statistical tests included Wilcoxon rank-sum for numeric outcomes and chi-squared or Fisher’s exact for categorical variables, with significance set at P < 0.05.
The results showed that out of 674 individuals with AF RVR treated with diltiazem, 386 met the inclusion criteria. The median age was 72 years (64–81), and 14.5% had a history of congestive heart failure. The EF < 50% was observed in 13.7% (n = 53), with 30% of these safely discharged home after intravenous (i.v.) diltiazem. Worsening heart failure occurred in 7 out of 41 (17%) individuals with reduced EF and 10 out of 207 (4.8%) with preserved EF (P= 0.005) among those admitted to the hospital.
Investigators concluded the development of worsening heart failure in patients with critically illness requiring hospital admission might be multifactorial, potentially including the use of diltiazem.
Source: sciencedirect.com/science/article/abs/pii/S0736467924002105
