TY - JOUR
T1 - Management of acute atrial fibrillation in the intensive care unit
T2 - An international survey
AU - the AFIB-ICU collaborators
AU - Wetterslev, Mik
AU - Møller, Morten Hylander
AU - Granholm, Anders
AU - Hassager, Christian
AU - Haase, Nicolai
AU - Aslam, Tayyba Naz
AU - Shen, Jiawei
AU - Young, Paul J.
AU - Aneman, Anders
AU - Hästbacka, Johanna
AU - Siegemund, Martin
AU - Cronhjort, Maria
AU - Lindqvist, Elin
AU - Myatra, Sheila N.
AU - Kalvit, Kushal
AU - Arabi, Yaseen M.
AU - Szczeklik, Wojciech
AU - Sigurdsson, Martin I.
AU - Balik, Martin
AU - Keus, Frederik
AU - Perner, Anders
AU - Huang, Bin
AU - Yan, Miao
AU - Liu, Wei
AU - Deng, Yanjiu
AU - Zhang, Lei
AU - Suk, Pavel
AU - Mørk Sørensen, Kasper
AU - Andreasen, Anne Sofie
AU - Bestle, Morten H.
AU - Krag, Mette
AU - Poulsen, Lone M.
AU - Hildebrandt, Thomas
AU - Møller, Kirsten
AU - Møller-Sørensen, Hasse
AU - Bove, Jeppe
AU - Kilsgaard, Toke A.
AU - Salam, Idrees Ahmad
AU - Brøchner, Anne Craveiro
AU - Strøm, Thomas
AU - Sølling, Christoffer
AU - Kolstrup, Line
AU - Boczan, Mariusz
AU - Rasmussen, Bodil S.
AU - Darfelt, Iben S.
AU - Jalkanen, Ville
AU - Lehto, Pasi
AU - Reinikainen, Matti
AU - Kárason, Sigurbergur
AU - Eck, Ruben J.
N1 - Funding Information:
MW’s salary was supported by the Research Council of Rigshospitalet, The Danish Society of Anesthesiology and Intensive Care Medicine (DASAIM), and Aase and Ejnar Danielsens Foundation, Ehrenreichs Foundation. None of the funders had any influence on study conduct and reporting.
Funding Information:
MW received support from the Ehrenreichs Foundation, Danish Society of Anaesthesiology and Intensive Care Medicine (DASAIM), and Research Council of Rigshospitalet, Copenhagen, Denmark.
Publisher Copyright:
© 2021 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
PY - 2022/3
Y1 - 2022/3
N2 - 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.
AB - 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.
KW - anticoagulant therapy
KW - atrial fibrillation
KW - intensive care unit
KW - management strategies
U2 - 10.1111/aas.14007
DO - 10.1111/aas.14007
M3 - Article
AN - SCOPUS:85121116321
SN - 0001-5172
VL - 66
SP - 375
EP - 385
JO - Acta Anaesthesiologica Scandinavica
JF - Acta Anaesthesiologica Scandinavica
IS - 3
ER -