{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T12:20:08Z","timestamp":1765369208975},"reference-count":35,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2017,11,10]],"date-time":"2017-11-10T00:00:00Z","timestamp":1510272000000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000222","name":"Heart and Stroke Foundation of Canada","doi-asserted-by":"publisher","award":["NA 7072"],"award-info":[{"award-number":["NA 7072"]}],"id":[{"id":"10.13039\/501100000222","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000226","name":"Ontario Ministry of Health and Long-Term Care","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000226","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Rate control is an important component of the management of patients with atrial fibrillation (<jats:styled-content style=\"fixed-case\">AF<\/jats:styled-content>). Previous studies of emergency department (<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>) rate control have been limited by relatively small sample sizes. We examined the use of beta\u2010blockers (<jats:styled-content style=\"fixed-case\">BB<\/jats:styled-content>s) versus nondihydropyridine calcium channel blockers (<jats:styled-content style=\"fixed-case\">CCB<\/jats:styled-content>s) in <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> patients from 24 sites and the associated hospital admission rates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this preplanned substudy, we examined chart data on <jats:styled-content style=\"fixed-case\">AF<\/jats:styled-content> patients who visited one of 24 hospital <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>s in Ontario, Canada, between April 2008 and March 2009. We describe the proportion of patients who received either a <jats:styled-content style=\"fixed-case\">BB<\/jats:styled-content> or a <jats:styled-content style=\"fixed-case\">CCB<\/jats:styled-content>, had a heart rate\u00a0&lt;\u00a0110 beats\/min 2 hours later, and had any complications. We used hierarchical logistic regression modeling to determine the predictors of <jats:styled-content style=\"fixed-case\">BB<\/jats:styled-content> versus <jats:styled-content style=\"fixed-case\">CCB<\/jats:styled-content> use and to assess the between\u2010hospital variation in use of <jats:styled-content style=\"fixed-case\">BB<\/jats:styled-content>s versus <jats:styled-content style=\"fixed-case\">CCB<\/jats:styled-content>s. Solely in patients who had no rhythm control attempts, we examined the difference in the probability of hospital admission after propensity score matching patients by medication class.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 1,639 patients who received either a <jats:styled-content style=\"fixed-case\">BB<\/jats:styled-content> (<jats:italic>n\u00a0=<\/jats:italic>\u00a0429) or a <jats:styled-content style=\"fixed-case\">CCB<\/jats:styled-content> (<jats:italic>n\u00a0=<\/jats:italic>\u00a01,210), 70.9% of the patients who received a <jats:styled-content style=\"fixed-case\">BB<\/jats:styled-content> had successful rate control versus 66.1% for a <jats:styled-content style=\"fixed-case\">CCB<\/jats:styled-content>. Complications were rare (2.4%), and the large majority were hypotension (2.0%). In adjusted analyses, predictors of receiving a <jats:styled-content style=\"fixed-case\">BB<\/jats:styled-content> (compared to a <jats:styled-content style=\"fixed-case\">CCB<\/jats:styled-content>) included already being on a <jats:styled-content style=\"fixed-case\">BB<\/jats:styled-content>, being sent in from a doctor's office, or being seen at a teaching hospital. In contrast, patients with evidence of heart failure, prior use of a <jats:styled-content style=\"fixed-case\">CCB<\/jats:styled-content>, a higher presenting heart rate, or a successful pharmacologic cardioversion (vs. no attempt) or who were seen at the highest <jats:styled-content style=\"fixed-case\">AF<\/jats:styled-content> volume <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>s were significantly less likely to receive a <jats:styled-content style=\"fixed-case\">BB<\/jats:styled-content>, compared to a <jats:styled-content style=\"fixed-case\">CCB<\/jats:styled-content>. Systematic between\u2010hospital differences accounted for 8% of the variation in <jats:styled-content style=\"fixed-case\">BB<\/jats:styled-content> versus <jats:styled-content style=\"fixed-case\">CCB<\/jats:styled-content> use. Hospital characteristics accounted for the large majority of that variation: after accounting for patient characteristics the between\u2010hospital variation decreased by a relative 2.8%. By further adjusting for hospital characteristics, it decreased by a relative 74.7%. Among propensity score\u2013matched patients with no rhythm control attempts, more <jats:styled-content style=\"fixed-case\">CCB<\/jats:styled-content> patients were admitted (51.6%) compared to <jats:styled-content style=\"fixed-case\">BB<\/jats:styled-content> patients (40.0%; difference of 11.6%; 95% confidence interval\u00a0= 7.9%\u201316.2%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In this study of 24 <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>s, <jats:styled-content style=\"fixed-case\">CCB<\/jats:styled-content>s were used more frequently for rate control than <jats:styled-content style=\"fixed-case\">BB<\/jats:styled-content>s, and complications were rare and easily managed using both agents. Variation between hospitals in <jats:styled-content style=\"fixed-case\">BB<\/jats:styled-content> versus <jats:styled-content style=\"fixed-case\">CCB<\/jats:styled-content> use was predominantly due to hospital characteristics such as teaching status and <jats:styled-content style=\"fixed-case\">AF<\/jats:styled-content> volumes, rather than different case mix. Among patients who did not receive attempts at rhythm control, use of a <jats:styled-content style=\"fixed-case\">BB<\/jats:styled-content> for rate control was associated with a lower rate of hospitalization.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13303","type":"journal-article","created":{"date-parts":[[2017,8,29]],"date-time":"2017-08-29T22:56:51Z","timestamp":1504047411000},"page":"1334-1348","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Rate Control With Beta\u2010blockers Versus Calcium Channel Blockers in the Emergency Setting: Predictors of Medication Class Choice and Associated Hospitalization"],"prefix":"10.1111","volume":"24","author":[{"given":"Clare L.","family":"Atzema","sequence":"first","affiliation":[{"name":"Department of Trauma, Emergency and Critical Care Sunnybrook Health Sciences Centre Toronto Ontario Canada"},{"name":"Institute for Clinical Evaluative Sciences Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter C.","family":"Austin","sequence":"additional","affiliation":[{"name":"Institute for Clinical Evaluative Sciences Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,11,10]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2013.06.005"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2007.03.007"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.01.064"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2010.07.005"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2010.11.014"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000040"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2014.08.001"},{"key":"e_1_2_7_9_1","first-page":"9B","article-title":"2004 Canadian Cardiovascular Society Consensus Conference: Atrial Fibrillation","volume":"21","year":"2005","journal-title":"Can J Cardiol"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2014.12.010"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/MEJ.0000000000000227"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2015.01.014"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12091"},{"issue":"658","key":"e_1_2_7_14_1","first-page":"e6","article-title":"A clinical decision instrument for 30\u2010day death after an emergency department visit for atrial fibrillation: the Atrial Fibrillation in the Emergency Room (AFTER) study","volume":"66","author":"Atzema CL","year":"2015","journal-title":"Ann Emerg Med"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12078"},{"key":"e_1_2_7_16_1","unstructured":"Canadian Institute for Health Information.National Ambulatory Care Reporting System (NACRS) Metadata. 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