TY - JOUR

T1 - Management of acute atrial fibrillation in the intensive care unit

T2 - An international survey

AU - Wetterslev, Mik

AU - Møller, Morten Hylander

AU - Granholm, Anders

AU - Hassager, Christian

AU - Haase, Nicolai

AU - Aslam, Tayyba Naz

AU - Shen, Jiawei

AU - Young, Paul J.

AU - Aneman, Anders

AU - Hästbacka, Johanna

AU - Siegemund, Martin

AU - Cronhjort, Maria

AU - Lindqvist, Elin

AU - Myatra, Sheila N.

AU - Kalvit, Kushal

AU - Arabi, Yaseen M.

AU - Szczeklik, Wojciech

AU - Sigurdsson, Martin I.

AU - Balik, Martin

AU - Keus, Frederik

AU - Perner, Anders

AU - Huang, Bin

AU - Yan, Miao

AU - Liu, Wei

AU - Deng, Yanjiu

AU - Zhang, Lei

AU - Suk, Pavel

AU - Mørk Sørensen, Kasper

AU - Andreasen, Anne Sofie

AU - Bestle, Morten H.

AU - Krag, Mette

AU - Poulsen, Lone M.

AU - Hildebrandt, Thomas

AU - Møller, Kirsten

AU - Møller-Sørensen, Hasse

AU - Bove, Jeppe

AU - Kilsgaard, Toke A.

AU - Salam, Idrees Ahmad

AU - Brøchner, Anne Craveiro

AU - Strøm, Thomas

AU - Sølling, Christoffer

AU - Kolstrup, Line

AU - Boczan, Mariusz

AU - Rasmussen, Bodil S.

AU - Darfelt, Iben S.

AU - Jalkanen, Ville

AU - Lehto, Pasi

AU - Reinikainen, Matti

AU - Kárason, Sigurbergur

AU - Sigvaldason, Kristinn

AU - the AFIB-ICU collaborators

N1 - Funding Information: MW’s salary was supported by the Research Council of Rigshospitalet, The Danish Society of Anesthesiology and Intensive Care Medicine (DASAIM), and Aase and Ejnar Danielsens Foundation, Ehrenreichs Foundation. None of the funders had any influence on study conduct and reporting. Funding Information: MW received support from the Ehrenreichs Foundation, Danish Society of Anaesthesiology and Intensive Care Medicine (DASAIM), and Research Council of Rigshospitalet, Copenhagen, Denmark. Publisher Copyright: © 2021 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

PY - 2021

Y1 - 2021

N2 - Background: Atrial fibrillation (AF) is common in intensive care unit (ICU) patients and is associated with poor outcomes. Different management strategies exist, but the evidence is limited and derived from non-ICU patients. This international survey of ICU doctors evaluated the preferred management of acute AF in ICU patients. Method: We conducted an international online survey of ICU doctors with 27 questions about the preferred management of acute AF in the ICU, including antiarrhythmic therapy in hemodynamically stable and unstable patients and use of anticoagulant therapy. Results: A total of 910 respondents from 70 ICUs in 14 countries participated in the survey with 24%–100% of doctors from sites responding. Most ICUs (80%) did not have a local guideline for the management of acute AF. The preferred first-line strategy for the management of hemodynamically stable patients with acute AF was observation (95% of respondents), rhythm control (3%), or rate control (2%). For hemodynamically unstable patients, the preferred strategy was observation (48%), rhythm control (48%), or rate control (4%). Overall, preferred antiarrhythmic interventions included amiodarone, direct current cardioversion, beta-blockers other than sotalol, and magnesium in that order. A total of 67% preferred using anticoagulant therapy in ICU patients with AF, among whom 61% preferred therapeutic dose anticoagulants and 39% prophylactic dose anticoagulants. Conclusion: This international survey indicated considerable practice variation among ICU doctors in the clinical management of acute AF, including the overall management strategies and the use of antiarrhythmic interventions and anticoagulants.

AB - Background: Atrial fibrillation (AF) is common in intensive care unit (ICU) patients and is associated with poor outcomes. Different management strategies exist, but the evidence is limited and derived from non-ICU patients. This international survey of ICU doctors evaluated the preferred management of acute AF in ICU patients. Method: We conducted an international online survey of ICU doctors with 27 questions about the preferred management of acute AF in the ICU, including antiarrhythmic therapy in hemodynamically stable and unstable patients and use of anticoagulant therapy. Results: A total of 910 respondents from 70 ICUs in 14 countries participated in the survey with 24%–100% of doctors from sites responding. Most ICUs (80%) did not have a local guideline for the management of acute AF. The preferred first-line strategy for the management of hemodynamically stable patients with acute AF was observation (95% of respondents), rhythm control (3%), or rate control (2%). For hemodynamically unstable patients, the preferred strategy was observation (48%), rhythm control (48%), or rate control (4%). Overall, preferred antiarrhythmic interventions included amiodarone, direct current cardioversion, beta-blockers other than sotalol, and magnesium in that order. A total of 67% preferred using anticoagulant therapy in ICU patients with AF, among whom 61% preferred therapeutic dose anticoagulants and 39% prophylactic dose anticoagulants. Conclusion: This international survey indicated considerable practice variation among ICU doctors in the clinical management of acute AF, including the overall management strategies and the use of antiarrhythmic interventions and anticoagulants.

KW - anticoagulant therapy

KW - atrial fibrillation

KW - intensive care unit

KW - management strategies

U2 - 10.1111/aas.14007

DO - 10.1111/aas.14007

M3 - Journal article

C2 - 34870855

AN - SCOPUS:85121116321

VL - 66

SP - 375

EP - 385

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

SN - 0001-5172

IS - 3

ER -