Abstract
Introduction
Atrial fibrillation and atrial flutter are common supraventricular arrhythmias in
patients who present to the emergency department. Under the American Heart Association
guidelines, dilTIAZem is the calcium channel blocker frequently used by many practitioners
for rate control. Currently, institution-specific data have identified that many patients
receiving dilTIAZem for atrial fibrillation or atrial flutter are given initial doses
that exceed the recommended dose by more than 10%, resulting in hypotension in some
patients.
Methods
ED personnel were surveyed to determine their current knowledge of appropriate intravenous
dilTIAZem dosing and methods of prescribing intravenous dilTIAZem to determine the
causes of higher dosing. Based on the baseline data, an intervention of adding a text
alert when withdrawing dilTIAZem from the automated medication dispensing cabinet
was implemented.
Results
Following the intervention, 29 patients received intravenous dilTIAZem for rate control
of atrial fibrillation or flutter with rapid ventricular response. For the primary
outcome, the incidence of high-dose dilTIAZem decreased by 19% (P = 0.03). There was no change in the secondary outcome of a reduction in hypotension
(P = 0.3).
Discussion
The interventions of education and medication alerts resulted in a significant increase
in the percentage of patients receiving appropriate doses of dilTIAZem and a nonsignificant
decrease in the incidence of hypotension. This process-oriented intervention resulted
in an improvement in appropriate dilTIAZem doses at our site. Rate control was not
statistically significantly different between the 2 groups. Long-term sustainability
of this intervention requires further study.
Key words
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References
- 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation.Circulation. 2014; 130: 2071-2104https://doi.org/10.1161/CIR.0000000000000041
- 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS.Rev Española Cardiol Engl Ed. 2017; 70: 50https://doi.org/10.1016/j.rec.2016.11.033
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- Diltiazem vs. metoprolol in the management of atrial fibrillation or flutter with rapid ventricular rate in the emergency department.J Emerg Med. 2015; 49: 175-182https://doi.org/10.1016/j.jemermed.2015.01.014
- Diltiazem versus metoprolol for rate control in atrial fibrillation with rapid ventricular response in the emergency department.Am J Health Syst Pharm. 2016; 73: 2068-2076https://doi.org/10.2146/ajhp160126
Solis L, Hartman H, Gass J, Pelsue B. Diltiazem in atrial fibrillation and/or atrial flutter with rapid ventricular response in the emergency center. Poster presented at: The American Society of Health System Pharmacists Midyear Annual Meeting; December 8, 2016: Las Vegas, NV.
Diltiazem. In: Lexicomp. Husdon, OH: Wolters Kluwer Health. Updated August 30, 2019. Accessed September 1, 2019.
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Biography
Gregory Pon is a PGY-1 Pharmacy Resident, Department of Pharmacy, Memorial Hermann Texas Medical Center, Houston, TX. ORCID identifier: http://orcid.org/0000-0001-9185-931X
Biography
Brittany Pelsue is PGY1 Pharmacy Residency Program Director, and Clinical Pharmacist Specialist, Emergency Medicine, Memorial Hermann Texas Medical Center, Houston, TX. ORCID identifier: http://orcid.org/0000-0002-3643-4033
Biography
Brian Gulbis is a clinical pharmacy specialist, Cardiovascular Surgery, Memorial Hermann Texas Medical Center, Houston, TX. ORCID identifier: http://orcid.org/0000-0001-6398-4455
Article Info
Publication History
Published online: December 12, 2019
Footnotes
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Identification
Copyright
© 2019 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
