Patients with new-onset atrial fibrillation (NOAF) are frequently admitted to an intensive care unit (ICU). It is, however, linked to an increase in morbidity and mortality.
A group of UK researchers conducted a systematic review to summarize comparative evidence to inform about new onset atrial fibrillation (NOAF) therapy for patients admitted to the ICU.
In March 2019, a comprehensive search of MEDLINE, CINAHL, EMBASE, OpenGrey, Web of Science, Cochrane Database of Systematic Reviews, EU Clinical Trials Register, new WHO ICTRP trial databases, and the NIHR Clinical Trials Gateway, etc. were conducted by the researchers. Trials that evaluated the various treatment and preventive strategies of NOAF in general medicine, surgical or mixed adult ICUs were included. The researchers recorded all of the study's information on study-specific forms, including population demographics, methods assessing confounding, intervention, and comparator(s), results, and recommendations for future research. Only 42 publications were found to be qualified out of 3,651 total citations. There were 25 primary studies, 12 review articles, and 5 surveys/opinion papers among 42 publications. NOAF was defined in a variety of ways, ranging from 30 seconds to more than 24 hours. Anticoagulation's effects were only studied in one comparative study.
Calcium channel blockers (CCBs) appear to cause slower rhythm control than beta blockers, according to 1 research, and higher cardiovascular instability than amiodarone in another study. Beta-blocker and amiodarone medication may regulate heart rate in a similar way, as per evidence from four non-randomized trials. Compared to amiodarone, calcium channel blockers (CCBs), and digoxin, beta-blockers are linked to a lower risk of death; however, the data is mixed. The minimal evidence currently available does not support therapeutic anticoagulation during ICU admission.
Though the available evidence suggests the superiority of beta-blockers or amiodarone to calcium channel blockers (CCBs) for the primary treatment of undifferentiated ICU patients, the researchers conclude that the use of therapeutic anticoagulation for NOAF in critically ill patients is still limited due to lack of sufficient evidence.