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Pharmacological cardioversion for atrial fibrillation and flutter

Overview of attention for article published in Cochrane database of systematic reviews, November 2017
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Title
Pharmacological cardioversion for atrial fibrillation and flutter
Published in
Cochrane database of systematic reviews, November 2017
DOI 10.1002/14651858.cd003713.pub3
Pubmed ID
Authors

John Cordina, Gillian E Mead

Abstract

Atrial fibrillation is the commonest cardiac dysrhythmia. It is associated with significant morbidity and mortality. There are two approaches to the management of atrial fibrillation: controlling the ventricular rate or converting to sinus rhythm in the expectation that this would abolish its adverse effects. To assess the effects of pharmacological cardioversion of atrial fibrillation in adults on the annual risk of stroke, peripheral embolism, and mortality. We searched the Cochrane Controlled Trials Register (Issue 3, 2002), MEDLINE (2000 to 2002), EMBASE (1998 to 2002), CINAHL (1982 to 2002), Web of Science (1981 to 2002). We hand searched the following journals: Circulation (1997 to 2002), Heart (1997 to 2002), European Heart Journal (1997-2002), Journal of the American College of Cardiology (1997-2002) and selected abstracts published on the web site of the North American Society of Pacing and Electrophysiology (2001, 2002). Randomised controlled trials or controlled clinical trials of pharmacological cardioversion versus rate control in adults (>18 years) with acute, paroxysmal or sustained atrial fibrillation or atrial flutter, of any duration and of any aetiology. One reviewer applied the inclusion criteria and extracted the data. Trial quality was assessed and the data were entered into RevMan. We identified two completed studies AFFIRM (n=4060) and PIAF (n=252). We found no difference in mortality between rhythm control and rate control relative risk 1.14 (95% confidence interval 1.00 to 1.31).Both studies show significantly higher rates of hospitalisation and adverse events in the rhythm control group and no difference in quality of life between the two treatment groups.In AFFIRM there was a similar incidence of ischaemic stroke, bleeding and systemic embolism in the two groups. Certain malignant dysrhythmias were significantly more likely to occur in the rhythm control group. There were similar scores of cognitive assessment.In PIAF, cardioverted patients enjoyed an improved exercise tolerance but there was no overall benefit in terms of symptom control or quality of life. There is no evidence that pharmacological cardioversion of atrial fibrillation to sinus rhythm is superior to rate control. Rhythm control is associated with more adverse effects and increased hospitalisation. It does not reduce the risk of stroke. The conclusions cannot be generalised to all people with atrial fibrillation. Most of the patients included in these studies were relatively older (>60 years) with significant cardiovascular risk factors.

Twitter Demographics

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Mendeley readers

The data shown below were compiled from readership statistics for 176 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United States 2 1%
United Kingdom 2 1%
Germany 2 1%
Bosnia and Herzegovina 1 <1%
Italy 1 <1%
Spain 1 <1%
India 1 <1%
Unknown 166 94%

Demographic breakdown

Readers by professional status Count As %
Student > Master 38 22%
Researcher 27 15%
Student > Ph. D. Student 23 13%
Student > Bachelor 23 13%
Unspecified 21 12%
Other 44 25%
Readers by discipline Count As %
Medicine and Dentistry 95 54%
Unspecified 31 18%
Nursing and Health Professions 9 5%
Agricultural and Biological Sciences 8 5%
Pharmacology, Toxicology and Pharmaceutical Science 8 5%
Other 25 14%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 17 November 2017.
All research outputs
#10,024,136
of 12,527,219 outputs
Outputs from Cochrane database of systematic reviews
#9,191
of 9,882 outputs
Outputs of similar age
#270,967
of 378,429 outputs
Outputs of similar age from Cochrane database of systematic reviews
#162
of 172 outputs
Altmetric has tracked 12,527,219 research outputs across all sources so far. This one is in the 11th percentile – i.e., 11% of other outputs scored the same or lower than it.
So far Altmetric has tracked 9,882 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 20.5. This one is in the 3rd percentile – i.e., 3% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 378,429 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 16th percentile – i.e., 16% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 172 others from the same source and published within six weeks on either side of this one. This one is in the 1st percentile – i.e., 1% of its contemporaries scored the same or lower than it.