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Internal and Emergency Medicine

, Volume 12, Issue 5, pp 693–703 | Cite as

Guidelines on the management of atrial fibrillation in the emergency department: a critical appraisal

  • Giorgio CostantinoEmail author
  • Gian Marco Podda
  • Lorenzo Falsetti
  • Primiano Iannone
  • Ana Lages
  • Alberto M. Marra
  • Maristella Masala
  • Olaug Marie Reiakvam
  • Florentia Savva
  • Jan Schovanek
  • Sjoerd van Bree
  • Inês João da Silva Chora
  • Graziella Privitera
  • Silvio Ragozzino
  • Matthias von Rotz
  • Lycke Woittiez
  • Christopher Davidson
  • Nicola Montano
CE - ORIGINAL

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.

Keywords

Atrial fibrillation Emergency department Guidelines Evidence-based medicine Critical appraisal 

Notes

Acknowledgements

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.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

None.

Supplementary material

11739_2016_1580_MOESM1_ESM.docx (73 kb)
Supplementary material 1 (DOCX 73 kb)
11739_2016_1580_MOESM2_ESM.docx (14 kb)
Supplementary material 2 (DOCX 14 kb)

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Copyright information

© SIMI 2016

Authors and Affiliations

  • Giorgio Costantino
    • 1
    Email author
  • Gian Marco Podda
    • 2
  • Lorenzo Falsetti
    • 3
  • Primiano Iannone
    • 4
  • Ana Lages
    • 5
  • Alberto M. Marra
    • 6
  • Maristella Masala
    • 7
  • Olaug Marie Reiakvam
    • 5
  • Florentia Savva
    • 5
  • Jan Schovanek
    • 5
  • Sjoerd van Bree
    • 5
  • Inês João da Silva Chora
    • 5
  • Graziella Privitera
    • 5
  • Silvio Ragozzino
    • 5
  • Matthias von Rotz
    • 5
  • Lycke Woittiez
    • 5
  • Christopher Davidson
    • 8
  • Nicola Montano
    • 1
  1. 1.Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Dipartimento di Medicina Interna, Allergologia Immunologia ClinicaUniversità degli Studi di MilanoMilanItaly
  2. 2.Unità di Medicina 3, Dipartimento di medicina InternaASST Santi Paolo e CarloMilanItaly
  3. 3.Medicina Interna Generale e SemintensivaAzienda Ospedaliero-Universitaria “Ospedali Riuniti”AnconaItaly
  4. 4.Dipartimento di EmergenzaOspedale del Tigullio, ASL4 ChiavareseGenoaItaly
  5. 5.The 22nd European Summer School of Internal MedicineMuraveraItaly
  6. 6.IRCCS S.D.N.NaplesItaly
  7. 7.Azienda Ospedaliera Universitaria AOU Sassari Medicina InternaSassariItaly
  8. 8.European School of Internal MedicineMuraveraItaly

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