title: Safety and efficiency of calcium channel blockers versus beta-blockers for rate control in patients with atrial fibrillation and no acute underlying medical illness.
abstract: OBJECTIVE
  Many patients with atrial fibrillation (AF) are not candidates for rhythm control and may require rate control, typically with beta-blocking (BB) or calcium channel blocking (CCB) agents. Although these patients appear to have a low 30-day rate of stroke or death, it is unclear if one class of agent is safer or more effective. The objective was to determine whether BBs or CCBs would have a lower hospital admission rate and to measure 30-day safety outcomes including stroke, death, and emergency department (ED) revisits.
  
  
  METHODS
  This retrospective cohort study used a database from two urban EDs to identify consecutive patients with ED discharge diagnoses of AF from April 1, 2006, to March 31, 2010. Comorbidities, rhythms, management, and immediate outcomes were obtained by manual chart review, and patients with acute underlying medical conditions were excluded by predefined criteria. Patients managed only with rate control agents were eligible for review, and patients receiving BB agents were compared to those receiving CCB agents. The primary outcome was the proportion of patients requiring hospital admission; secondary outcomes included the ED length of stay (LOS), the proportion of patients having adverse events, the proportion of patients returning within 7 or 30 days, and the number of patients having a stroke or dying within 30 days.
  
  
  RESULTS
  A total of 259 consecutive patients were enrolled, with 100 receiving CCBs and 159 receiving BBs. Baseline demographics and comorbidities were similar. Twenty-seven percent of BB patients were admitted, and 31.0% of CCB patients were admitted (difference = 4.0%, 95% confidence interval [CI] = -7.7% to 16.1%), and there were no significant differences in ED LOS, adverse events, or 7- or 30-day ED revisits. One patient who received metoprolol had a stroke, and one patient who received diltiazem died within 30 days.
  
  
  CONCLUSIONS
  In this cohort of ED patients with AF and no acute underlying medical illness who underwent rate control only, patients receiving CCBs had similar hospital admission rates to those receiving BBs, while both classes of medications appeared equally safe at 30 days. Both CCBs and BBs are acceptable options for rate control.
authors.affiliation: Department of Emergency Medicine, St. Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada. frank.scheuermeyer@gmail.com
authors.forename: Frank Xavier
authors.initials: FX
authors.lastname: Scheuermeyer
authors.forename: Eric
authors.initials: E
authors.lastname: Grafstein
authors.forename: Rob
authors.initials: R
authors.lastname: Stenstrom
authors.forename: Jim
authors.initials: J
authors.lastname: Christenson
authors.forename: Claire
authors.initials: C
authors.lastname: Heslop
authors.forename: Brett
authors.initials: B
authors.lastname: Heilbron
authors.forename: Lorraine
authors.initials: L
authors.lastname: McGrath
authors.forename: Grant
authors.initials: G
authors.lastname: Innes
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology; D002121:Calcium Channel Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers