Abstract：
The objective was to evaluate the comparative effectiveness and safety of pharmacological and nonpharmacological management options for atrial fibrillation/atrial flutter with rapid ventricular response (AFRVR) in patients with acute decompensated heart failure (ADHF) in the acute care setting.
This study was a systematic review of observational studies or randomized clinical trials (RCT) of adult patients with AFRVR and concomitant ADHF in the emergency department (ED), intensive care unit, or step-down unit. The primary effectiveness outcome was successful rate or rhythm control. Safety outcomes were adverse events, such as symptomatic hypotension and venous thromboembolism.
A total of 6577 unique articles were identified. Five studies met inclusion criteria: one RCT in the inpatient setting and four retrospective studies, two in the ED and the other three in the inpatient setting. In the RCT of diltiazem versus placebo, 22 patients (100%) in the treatment group had a therapeutic response compared to 0/15 (0%) in the placebo group, with no significant safety differences between the two groups. For three of the observational studies, data were limited. One observation study showed no difference between metoprolol and diltiazem for successful rate control, but worsening heart failure symptoms occurred more frequently in those receiving diltiazem compared to metoprolol (19 patients [33%] vs. 10 patients [15%], p = 0.019). A single study included electrical cardioversion (one patient exposed with failure to convert to sinus rhythm) as nonpharmacological management. The overall risk of bias for included studies ranged from serious to critical. Missing data and heterogeneity of definitions for effectiveness and safety outcomes precluded the combination of results for quantitative meta-analysis.
High-level evidence to inform clinical decision making regarding effective and safe management of AFRVR in patients with ADHF in the acute care setting is lacking.
This study was a systematic review of observational studies or randomized clinical trials (RCT) of adult patients with AFRVR and concomitant ADHF in the emergency department (ED), intensive care unit, or step-down unit. The primary effectiveness outcome was successful rate or rhythm control. Safety outcomes were adverse events, such as symptomatic hypotension and venous thromboembolism.
A total of 6577 unique articles were identified. Five studies met inclusion criteria: one RCT in the inpatient setting and four retrospective studies, two in the ED and the other three in the inpatient setting. In the RCT of diltiazem versus placebo, 22 patients (100%) in the treatment group had a therapeutic response compared to 0/15 (0%) in the placebo group, with no significant safety differences between the two groups. For three of the observational studies, data were limited. One observation study showed no difference between metoprolol and diltiazem for successful rate control, but worsening heart failure symptoms occurred more frequently in those receiving diltiazem compared to metoprolol (19 patients [33%] vs. 10 patients [15%], p = 0.019). A single study included electrical cardioversion (one patient exposed with failure to convert to sinus rhythm) as nonpharmacological management. The overall risk of bias for included studies ranged from serious to critical. Missing data and heterogeneity of definitions for effectiveness and safety outcomes precluded the combination of results for quantitative meta-analysis.
High-level evidence to inform clinical decision making regarding effective and safe management of AFRVR in patients with ADHF in the acute care setting is lacking.
摘要：
目的：本研究的目的是评估急性失代偿性心力衰竭（ADHF）患者在急性护理环境中，快速心室反应（AFRVR）的心房颤动/扑动的药物和非药物治疗方案的有效性和安全性。
方法：本研究是对急诊科（ED）患有AFRVR并伴有ADHF的成年患者的观察性研究或随机临床试验（RCT）的系统评价，重症监护室,或降压单元。主要的有效性结果是成功率或节律控制。安全性结果为不良事件，如症状性低血压和静脉血栓栓塞。
结果：共鉴定出6577篇独特文章。五项研究符合纳入标准：一项住院患者的RCT和四项回顾性研究，两个在ED和其他三个在住院设置。在地尔硫与安慰剂的RCT中，与安慰剂组的0/15（0％）相比，治疗组中的22名患者（100％）具有治疗反应，两组间安全性无显著差异。对于三项观察性研究，数据有限。一项观察研究表明，美托洛尔和地尔硫卓在成功控制心率方面没有差异，但与美托洛尔相比，接受地尔硫治疗的患者出现心力衰竭症状恶化的频率更高(19例[33%]10名患者[15%]，p=0.019)。一项研究包括电复律（一名患者未能转换为窦性心律）作为非药物治疗。纳入研究的总体偏倚风险从严重到严重不等。有效性和安全性结果定义的数据缺失和异质性排除了定量荟萃分析的结果组合。
结论：缺乏高水平的证据来告知急性护理环境中ADHF患者AFRVR的有效和安全管理的临床决策。
方法：本研究是对急诊科（ED）患有AFRVR并伴有ADHF的成年患者的观察性研究或随机临床试验（RCT）的系统评价，重症监护室,或降压单元。主要的有效性结果是成功率或节律控制。安全性结果为不良事件，如症状性低血压和静脉血栓栓塞。
结果：共鉴定出6577篇独特文章。五项研究符合纳入标准：一项住院患者的RCT和四项回顾性研究，两个在ED和其他三个在住院设置。在地尔硫与安慰剂的RCT中，与安慰剂组的0/15（0％）相比，治疗组中的22名患者（100％）具有治疗反应，两组间安全性无显著差异。对于三项观察性研究，数据有限。一项观察研究表明，美托洛尔和地尔硫卓在成功控制心率方面没有差异，但与美托洛尔相比，接受地尔硫治疗的患者出现心力衰竭症状恶化的频率更高(19例[33%]10名患者[15%]，p=0.019)。一项研究包括电复律（一名患者未能转换为窦性心律）作为非药物治疗。纳入研究的总体偏倚风险从严重到严重不等。有效性和安全性结果定义的数据缺失和异质性排除了定量荟萃分析的结果组合。
结论：缺乏高水平的证据来告知急性护理环境中ADHF患者AFRVR的有效和安全管理的临床决策。
