An Evaluation of Administration Methods of Intravenous Diltiazem in the Emergency Department - Potential for Cost-Savings

Background: Intravenous (IV) diltiazem is commonly used in the emergency setting for the treatment of atrial fibrillation/flutter (AF) and supraventricular tachycardia (SVT).It can be administered as an intravenous bolus (IVB) dose, short infusion (SI), or continuous infusion (CI).The current study aimed to compare the efficacy, safety, and cost-effectiveness of different methods for administering IV diltiazem in the emergency department (ED).Methods: This single-center retrospective study enrolled patients who received IV diltiazem for AF or SVT in the ED in 2020.Patients were stratified according to the treatment indications and IV administration methods, which were as follows: IVB, SI (over 10-20 minutes), and CI.Results: Sixty-one patients were included in the analysis; of these, 35 (57.4%) patients were treated for AF.Fifteen (24.6%), 13 (21.3%),and 33 (54.1%) patients received diltiazem as an IVB, SI, and CI, respectively.The average doses of IVB and SI of diltiazem used were 0.22 and 0.42 mg/kg, respectively.Twenty-three (88.5%) patients treated for SVT had conversion of SVT back to a sinus rhythm post-diltiazem administration.Among the remaining three patients who failed diltiazem, two received CI and one received SI.Three (4.9%) patients developed significant hypotension after receiving diltiazem; of these, one received an IVB of diltiazem and two received a CI.Among the patients receiving CI of diltiazem, 48.1 mg of diltiazem per patient was discarded, amounting to approximately $77 per patient.Comparatively, 2.4 and 9.8 mg of diltiazem per patient were discarded for those receiving IVB or SI, respectively. Conclusion:Diltiazem was effective in treating SVT and AF in the ED.The safety profile of IV diltiazem for the treatment of AF or SVT appears to be similar, regardless of the administration method.Administering diltiazem as a CI leads to higher costs.