title: Guidelines on the management of atrial fibrillation in the emergency department: a critical appraisal.
abstract: Several guidelines often exist on the same topic, sometimes offering divergent recommendations. For the clinician, it can be difficult to understand the reasons for this divergence and how to select the right recommendations. The aim of this study is to compare different guidelines on the management of atrial fibrillation (AF), and provide practical and affordable advice on its management in the acute setting. A PubMed search was performed in May 2014 to identify the three most recent and cited published guidelines on AF. During the 1-week school of the European School of Internal Medicine, the attending residents were divided in five working groups. The three selected guidelines were compared with five specific questions. The guidelines identified were: the European Society of Cardiology guidelines on AF, the Canadian guidelines on emergency department management of AF, and the American Heart Association guidelines on AF. Twenty-one relevant sub-questions were identified. For five of these, there was no agreement between guidelines; for three, there was partial agreement; for three data were not available (issue not covered by one of the guidelines), while for ten, there was complete agreement. Evidence on the management of AF in the acute setting is largely based on expert opinion rather than clinical trials. While there is broad agreement on the management of the haemodynamically unstable patient and the use of drugs for rate-control strategy, there is less agreement on drug therapy for rhythm control and no agreement on several other topics.
authors.affiliation: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Dipartimento di Medicina Interna, Allergologia Immunologia Clinica, Università degli Studi di Milano, Via F. Sforza 34, Milan, Italy. giorgic2@gmail.com.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Costantino
authors.affiliation: Unità di Medicina 3, Dipartimento di medicina Interna, ASST Santi Paolo e Carlo, Milan, Italy.
authors.forename: Gian Marco
authors.initials: GM
authors.lastname: Podda
authors.affiliation: Medicina Interna Generale e Semintensiva, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Falsetti
authors.affiliation: Dipartimento di Emergenza, Ospedale del Tigullio, ASL4 Chiavarese, Lavagna, Genoa, Italy.
authors.forename: Primiano
authors.initials: P
authors.lastname: Iannone
authors.affiliation: The 22nd European Summer School of Internal Medicine, Muravera, Cagliari, Italy.
authors.forename: Ana
authors.initials: A
authors.lastname: Lages
authors.affiliation: IRCCS S.D.N., Naples, Italy.
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Marra
authors.affiliation: Azienda Ospedaliera Universitaria AOU Sassari Medicina Interna, Sassari, Italy.
authors.forename: Maristella
authors.initials: M
authors.lastname: Masala
authors.affiliation: The 22nd European Summer School of Internal Medicine, Muravera, Cagliari, Italy.
authors.forename: Olaug Marie
authors.initials: OM
authors.lastname: Reiakvam
authors.affiliation: The 22nd European Summer School of Internal Medicine, Muravera, Cagliari, Italy.
authors.forename: Florentia
authors.initials: F
authors.lastname: Savva
authors.affiliation: The 22nd European Summer School of Internal Medicine, Muravera, Cagliari, Italy.
authors.forename: Jan
authors.initials: J
authors.lastname: Schovanek
authors.affiliation: The 22nd European Summer School of Internal Medicine, Muravera, Cagliari, Italy.
authors.forename: Sjoerd
authors.initials: S
authors.lastname: van Bree
authors.affiliation: The 22nd European Summer School of Internal Medicine, Muravera, Cagliari, Italy.
authors.forename: Inês João
authors.initials: IJ
authors.lastname: da Silva Chora
authors.affiliation: The 22nd European Summer School of Internal Medicine, Muravera, Cagliari, Italy.
authors.forename: Graziella
authors.initials: G
authors.lastname: Privitera
authors.affiliation: The 22nd European Summer School of Internal Medicine, Muravera, Cagliari, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Ragozzino
authors.affiliation: The 22nd European Summer School of Internal Medicine, Muravera, Cagliari, Italy.
authors.forename: Matthias
authors.initials: M
authors.lastname: von Rotz
authors.affiliation: The 22nd European Summer School of Internal Medicine, Muravera, Cagliari, Italy.
authors.forename: Lycke
authors.initials: L
authors.lastname: Woittiez
authors.affiliation: European School of Internal Medicine, Muravera, Cagliari, Italy.
authors.forename: Christopher
authors.initials: C
authors.lastname: Davidson
authors.affiliation: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Dipartimento di Medicina Interna, Allergologia Immunologia Clinica, Università degli Studi di Milano, Via F. Sforza 34, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Montano
mesh_terms: D000925:Anticoagulants / Q000494:pharmacology / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000503:physiopathology; D019468:Disease Management; D004502:Education, Medical, Continuing / Q000379:methods; D004554:Electric Countershock / Q000379:methods / Q000592:standards; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine / Q000379:methods; D017408:Guidelines as Topic / Q000592:standards*; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans
chemical_list: D000925:Anticoagulants
keywords: Atrial fibrillation; Critical appraisal; Emergency department; Evidence-based medicine; Guidelines