Patient selection: atrial fibrillation with rapid heart rate (> 100 beats per minute) in community emergency department
Parameters:
(1) acute illness requiring hospitalization
(2) clinical conditions (acute coronary syndrome, acute heart failure, syncope or hemodynamic instability)
(3) CHADS2VASC score (? CHA2DS2-VASc, with range 0 to 9)
(4) INR
(5) heart rate in beats per minute
Admit to the hospital if either present:
(1) acute illness requiring hospitalization
(2) >= 1 clinical condition(s)
Perform synchronized cardioversion - at least one of the following:
(1) CHADS2VASC <= 1
(2) INR > 2
Discharge home:
(1) CHADS2VASC > 1 AND INR <= 2
(2) heart rate <= 110 beats per minute
Treat (avoid IV infusions) with metoprolol tartrate or diltiazem
(1) CHADS2VASC > 1 AND INR <= 2
(2) heart rate > 110 beats per minute
where:
• Dose for metoprolol: 50 mg bid po
• Dose of diltiazem: extended release 120 mg or 180 mg qd po
