This one’s a bit of a shorter one. I’d unfortunately gone on a binge of reading for that week’s journal club and had way too much on my plate, so didn’t bother writing a very long and in-depth review. Just the bullet points for this one!
Rossi, et al. 2023. Impact of intravenous calcium with diltiazem for atrial fibrillation/flutter in the emergency department. AJEM, 64, p57-61.
https://www.sciencedirect.com/science/article/pii/S0735675722007161
One Liner: IV calcium w/ IV diltiazem did not have any meaningful change to BP, hypotension, bradycardia, time to rate control, or time to achieve rate control; will not change my practice since I don’t give IV calcium anyways for this anyways.
Brief Summary:
- PICO: In patients with AFib/Aflutter w RVR (HR > 120), the intervention of adding IV calcium to IV diltiazem, compared to pts getting just IV diltiazem, measured the outcomes of [primary] change in systolic BP approx. 60 min after administration, with [secondary] time to initial and sustained rate control, change in HR, presence of hypotension, bradycardia, hypercalcemia, or IV extravasation.
- Exclusion criteria were unstable pts requiring cardioversion, pts taking other rate control Rx (e.g. amiodarone, digoxin, beta blockers), pregnant, and incarcerated individuals.
- Diltiazem monotherapy group (198 pts), Diltiazem w/ calcium (56 pts).
- A few notable differences in baseline characteristics; diltiazem + calcium group noted to have lower BP’s at baseline, greater rates of CKD, active malignancy; the diltiazem bolus was also lower in the calcium group (10 mg vs 15 mg), plus they used lower diltiazem boluses than usual dosing. The study was also under-powered in terms of pt recruitment.
- No statistically significant differences in any of the outcomes, primary or secondary.