Health Technology Assessment of Different Doses of Metoprolol for Atrial Fibrillation_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Hao ,  DONG Birong , YANG Min

Geriatric Department, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

DONG Birong, Email: 80wanghao@sina.com

Keywords：

Metoprolol; Atrial fibrillation; Dose; Health technology assessment

DOI：

10.7507/1672-2531.20080074

Video：

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Objective 　According to health technology assessment (HTA) methodology, to assess the efficacy and safety of different doses of metoprolol in the treatment of atrial fibrillation (AF).
Methods 　Based on the principles of HTA, we searched some important medical databases including MEDLINE, EMBASE, The Cochrane Library and CMCC, as well as several national special heart disease databases and side effect centers. We selected eligible studies based on the inclusion and exclusion criteria and critically assessed their quality.
Results 　Intravenous metoprolol 10 mg - 15 mg could control rapid ventricular rate in patients with chronic AF. On either rest or exercise, oral metoprolol 150 mg/d had a better control of rapid ventricular rate than 50 mg/d in patients with chronic AF. For preventing postoperative AF (POAF), the intravenous metoprolol 20 mg group and the 30 mg group could decrease the incidence of POAF compared to the 10 mg group. Oral metoprolol 150 mg/d was more effective than 100 mg/d in preventing POAF. In addition, intravenous metoprolol therapy was well-tolerated and more effective than oral metoprolol therapy in preventing atrial fibrillation after cardiac surgery. Results from several national side effect centers demonstrated that the incidence of adverse reactions associated with metoprolol was low.
Conclusion 　Present evidence showed that high dose of metoprolol was superior to low dose in treating AF, however, the evidence available is insufficient. It is suggested that adequate evidence through further studies are needed. The safety profile of different doses of metoprolol is similar.

Citation： WANG Hao,DONG Birong,YANG Min. Health Technology Assessment of Different Doses of Metoprolol for Atrial Fibrillation. Chinese Journal of Evidence-Based Medicine, 2008, 08(5): 334-339. doi: 10.7507/1672-2531.20080074 Copy

1.	Sra J, Dhala A, Blanck Z, et al. Atrial fibrillation: epidemiology, mechanisms, and management. Curr Probl Cardiol, 2000, 25(7): 405-524.
2.	Furberg CD, Psaty BM, Manolio TA, et al. Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study). Am J Cardiol, 1994, 74(3): 236-241.
3.	Stewart S, Hart CL, Hole DJ, et al. A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study. Am J Med, 2002, 113(5): 359-364.
4.	Krahn AD, Manfreda J, Tate RB, et al. The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study. Am J Med, 1995, 98(5): 476-484.
5.	Falk RH. Etiology and complications of atrial fibrillation: insights from pathology studies. Am J Cardiol, 1998, 82(8A): 10N-17N.
6.	Crystal E, Grafinkle MS, Connolly SS, et al. Interventions for preventing postoperative atrial fibrillation in patients undergoing heart surgery. Cochrane Database Syst Rev, 2004: CD003611.
7.	Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet, 1999, 354(9193): 1896-1900.
8.	Altman DG, Schulz KF, Moher D, et al. The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med, 2001, 134(8): 663-694.
9.	Cochrane Deeks JJ, Dinnes J, D’Amico R, et al. Evaluating non-randomised intervention studies. Health Technol Assess, 2003, 7(27):iii-x, 1-173.
10.	Helgerson, Steven D. MD, MPH; Holzman, Gregory S. MD, MPH Clinical Epidemiology: How to Do Clinical Practice Research. JAMA. 295(4):446, January 25, 2006. Wilkins, c2006.
11.	Amsterdam EA, Kulcyski J, Ridgeway MG. Efficacy of cardioselective beta-adrenergic blockade with intravenously administered metoprolol in the treatment of supraventricular tachyarrhythmias. J Clin Pharmacol, 1991, 31(8): 714-718.
12.	Booth JV, Ward EE, Colgan KC, et al. Metoprolol and Coronary Artery Bypass Grafting Surgery: Does Intraoperative Metoprolol Attenuate Acute β-Adrenergic Receptor Desensitization During Cardiac Surgery? Anesth Analg, 2004, 98(5): 1224-1231.
13.	Connolly SJ, Cybulsky I, Lamy A, et al. Double-blind, placebo-controlled, randomized trial of prophylactic metoprolol for reduction of hospital length of stay after heart surgery: the beta-Blocker Length Of Stay (BLOS) study. Am Heart J, 2003, 145(2): 226-232.
14.	Halonen J, Hakala T, Auvinen T, et al. Intravenous administration of metoprolol is more effective than oral administration in the prevention of atrial fibrillation after cardiac surgery. Circulation, 2006, 114(1 Suppl): I1-4.
15.	Möller B, Ringqvist C. Metoprolol in the treatment of supraventricular tachyarrhythmias. Ann Clin Res, 1979, 11(1): 34-41.
16.	Khalsa A, Edvardsson N, Olsson SB. Effects of metoprolol on heart rate in patients with digitalis treated chronic atrial fibrillation. Clin Cardiol, 1978, 1(2): 91-95.
17.	Metra M, Giubbini R, Nodari S, et al. Differential effects of beta-blockers in patients with heart failure: A prospective, randomized, double-blind comparison of the long-term effects of metoprolol versus carvedilol. Circulation, 2000, 102(5): 546-551.
18.	Pernat A, Pohar B, Horvat M. Heart conduction disturbances and cardiovascular collapse after disopyramide and low-dose metoprolol in a patient with hypertrophic obstructive cardiomyopathy. J Electrocardiol, 1997, 30(4): 341-344.
19.	Chen ZM, Pan HC, Chen YP, et al. Early intravenous then oral metoprolol in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet, 2005, 366(9497): 1622-1632.

1. Sra J, Dhala A, Blanck Z, et al. Atrial fibrillation: epidemiology, mechanisms, and management. Curr Probl Cardiol, 2000, 25(7): 405-524.
2. Furberg CD, Psaty BM, Manolio TA, et al. Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study). Am J Cardiol, 1994, 74(3): 236-241.
3. Stewart S, Hart CL, Hole DJ, et al. A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study. Am J Med, 2002, 113(5): 359-364.
4. Krahn AD, Manfreda J, Tate RB, et al. The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study. Am J Med, 1995, 98(5): 476-484.
5. Falk RH. Etiology and complications of atrial fibrillation: insights from pathology studies. Am J Cardiol, 1998, 82(8A): 10N-17N.
6. Crystal E, Grafinkle MS, Connolly SS, et al. Interventions for preventing postoperative atrial fibrillation in patients undergoing heart surgery. Cochrane Database Syst Rev, 2004: CD003611.
7. Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet, 1999, 354(9193): 1896-1900.
8. Altman DG, Schulz KF, Moher D, et al. The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med, 2001, 134(8): 663-694.
9. Cochrane Deeks JJ, Dinnes J, D’Amico R, et al. Evaluating non-randomised intervention studies. Health Technol Assess, 2003, 7(27):iii-x, 1-173.
10. Helgerson, Steven D. MD, MPH; Holzman, Gregory S. MD, MPH Clinical Epidemiology: How to Do Clinical Practice Research. JAMA. 295(4):446, January 25, 2006. Wilkins, c2006.
11. Amsterdam EA, Kulcyski J, Ridgeway MG. Efficacy of cardioselective beta-adrenergic blockade with intravenously administered metoprolol in the treatment of supraventricular tachyarrhythmias. J Clin Pharmacol, 1991, 31(8): 714-718.
12. Booth JV, Ward EE, Colgan KC, et al. Metoprolol and Coronary Artery Bypass Grafting Surgery: Does Intraoperative Metoprolol Attenuate Acute β-Adrenergic Receptor Desensitization During Cardiac Surgery? Anesth Analg, 2004, 98(5): 1224-1231.
13. Connolly SJ, Cybulsky I, Lamy A, et al. Double-blind, placebo-controlled, randomized trial of prophylactic metoprolol for reduction of hospital length of stay after heart surgery: the beta-Blocker Length Of Stay (BLOS) study. Am Heart J, 2003, 145(2): 226-232.
14. Halonen J, Hakala T, Auvinen T, et al. Intravenous administration of metoprolol is more effective than oral administration in the prevention of atrial fibrillation after cardiac surgery. Circulation, 2006, 114(1 Suppl): I1-4.
15. Möller B, Ringqvist C. Metoprolol in the treatment of supraventricular tachyarrhythmias. Ann Clin Res, 1979, 11(1): 34-41.
16. Khalsa A, Edvardsson N, Olsson SB. Effects of metoprolol on heart rate in patients with digitalis treated chronic atrial fibrillation. Clin Cardiol, 1978, 1(2): 91-95.
17. Metra M, Giubbini R, Nodari S, et al. Differential effects of beta-blockers in patients with heart failure: A prospective, randomized, double-blind comparison of the long-term effects of metoprolol versus carvedilol. Circulation, 2000, 102(5): 546-551.
18. Pernat A, Pohar B, Horvat M. Heart conduction disturbances and cardiovascular collapse after disopyramide and low-dose metoprolol in a patient with hypertrophic obstructive cardiomyopathy. J Electrocardiol, 1997, 30(4): 341-344.
19. Chen ZM, Pan HC, Chen YP, et al. Early intravenous then oral metoprolol in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet, 2005, 366(9497): 1622-1632.

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Chinese Journal of Evidence-Based Medicine

Health Technology Assessment of Different Doses of Metoprolol for Atrial Fibrillation

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