Guidelines on the management of atrial fibrillation in the emergency department: a critical appraisal
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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.
KeywordsAtrial fibrillation Emergency department Guidelines Evidence-based medicine Critical appraisal
2014 ESIM school residents: Arjola Bano, Sharry Kahlon, Demetra Tourva, Frini Karaolidou, Maibrit Loogna, Louise Caroline Aaltonen, Jyrki Mustonen, Jenni Koskela, Jan Reimer, Amr Abdin, Inga Tetruashvili, Hen Kayless, Maayan Sasson Ben, Teresa Vanessa Fiorentino, Valentina Tommasi, Marta Zanon, Anna Salina, Claire Den Hoedt, Tranheim Marte Kase, Joao Estevao, Nicolay Tsarev, Sanja Dragasevic, Noel Lorenzo Villalba, Eric Pascal Kuhn, Lia Jeker, Claudia Beerli, Imene Rachid, Ayse Bahar kelesoglu, Pinar Yildirim, Demet Sekure Arslan, and Richard Frederich De Butts. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Conflict of interest
The authors declare that they have no conflict of interest.
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This article does not contain any studies with human participants or animals performed by any of the authors.
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