Investigating the clinical and cost-effectiveness of two different drugs (amiodarone and beta blockers) to treat patients with new-onset atrial fibrillation whilst in the intensive care unit
| ISRCTN | ISRCTN59775011 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN59775011 |
| Integrated Research Application System (IRAS) | 1007930 |
| Central Portfolio Management System (CPMS) | 57843 |
| Protocol serial number | RG_22-153 |
| Sponsor | University of Birmingham |
| Funder | National Institute for Health and Care Research |
- Submission date
- 14/09/2023
- Registration date
- 15/09/2023
- Last edited
- 15/06/2026
- Recruitment status
- No longer recruiting
- Overall study status
- Ongoing
- Condition category
- Circulatory System
Plain English summary of protocol
Background and study aims
Each year about 10% of patients who are being treated in an ICU will develop an irregular heartbeat which they did not have previously, called new-onset atrial fibrillation (NOAF). We do not fully understand what causes NOAF in these patients but believe that it may be the result of a number of factors including:
1. Normal body reactions to infection and injury
2. Altered levels of electrolytes (salts) in a patient’s blood
3. The drugs used to support a patient’s blood pressure
4. Certain commonly used ICU procedures
Some of the studies to look at the risks associated with AF suggest that patients who develop NOAF whilst in the ICU seem to be at higher risk of complications such as heart attack and stroke, which means that they need to spend a longer time in hospital. Some patients who develop NOAF may also end up in permanent AF and require lifelong treatment. We need to do a trial because we do not have a clear understanding of the best way to treat these patients.
Who can participate?
Patients aged 16 years and over in an adult ICU who have developed NOAF
What does the study involve?
Participants will be randomly allocated to receive either amiodarone or beta-blockade. The choice of dose (and in the case of beta-blockade, the type) rests with the clinical team at site. Participants will be treated with the allocated intervention until sinus rhythm has been maintained for 24 hours. Clinicians should then consider stopping the intervention according to local practice. Both interventions can be administered by infusion/injection or orally.
Information will be collected from medical notes including the results of tests that are done as part of usual care. A researcher will monitor the patient's progress for 90 days from when they first joined the study and will collect information on:
1. The illness and treatment during their stay in ICU
2. The date the patient is discharged from ICU
3. The date the patient is discharged from hospital
4. How the patient feels around 60 days later (30-minute telephone call if discharged)
5. How the patient feels around 90 days later (30-minute telephone call if discharged)
What are the possible benefits and risks of participating?
While there is no direct benefit or financial incentives for patients that take part in this trial, the information provided by the trial may help in the long-term, to improve and shape future care for ICU patients who develop NOAF.
Where is the study run from?
The Birmingham Clinical Trials Unit (BCTU) coordinates the study at the University of Birmingham (UK)
When is the study starting and how long is it expected to run for?
October 2022 to December 2026
Who is funding the study?
The National Institute for Health and Care Research, Health Technology Assessment (UK)
Who is the main contact?
abbrupt@trials.bham.ac.uk
Contact information
Scientific
Birmingham Clinical Trials Unit
Birmingham
B15 2TT
United Kingdom
| Phone | +44 (0)121 414 7943 |
|---|---|
| abbrupt@trials.bham.ac.uk |
Principal investigator
University Hospitals Birmingham
Queen Elizabeth Hospital
Mindelsohn Way
Birmingham
B15 2GW
United Kingdom
 ORCID ID |
0000-0002-1508-8362 |
|---|---|
| Phone | +44 (0)121 371 7887 |
| Dhruv.Parekh@uhb.nhs.uk |
Study information
| Primary study design | Interventional |
|---|---|
| Study design | Multi-centre interventional randomized controlled open-label trial |
| Secondary study design | Randomised controlled trial |
| Scientific title | A randomised controlled trial to investigate the clinical and cost effectiveness of Amiodarone vs Beta Blockade for new-onset atrial fibRillation in icU - a Pragmatic sTudy (ABBRUPT) |
| Study acronym | ABBRUPT |
| Study objectives | The ABBRUPT trial will assess the clinical and cost-effectiveness of two commonly used treatments for new-onset atrial fibrillation (NOAF) in patients in ICU to establish which management of AF is best to avoid harm and achieve optimal outcomes. |
| Ethics approval(s) |
Approved 20/10/2023, South Central - Oxford C (2 Redman Place, Stratford, London, E20 1JQ, United Kingdom; None provided; oxfordc.rec@hra.nhs.uk), ref: 23/SC/0334 |
| Health condition(s) or problem(s) studied | New onset atrial fibrillation (NOAF) |
| Intervention | Patients will be randomised following confirmation of eligibility by a medically qualified doctor. They will be randomised to receive either amiodarone or beta-blockade. The choice of dose (and in the case of beta-blockade, the type) rests with the clinical team at site. Patients randomised to amiodarone will receive a loading dose (usually 300 mg over 1 hour) followed by a continuous infusion of (usually) between 300-1200 mg (usually 900 mg) per day with the treating clinician choosing the route of administration and duration. For those patients randomised to the control group, clinicians will be given the choice of beta-blocker: bisoprolol, metoprolol, esmolol, propranolol, atenolol, labetalol, carvedilol, and landiolol. The beta-blocker choice should reflect local availability and familiarity. They may be administered enterally or intravenously; dosing should be according to local practice. Patients will be treated with the allocated intervention until sinus rhythm has been maintained for 24 hours. Clinicians should then consider stopping the intervention according to local practice. All participants will be followed up for 90 days from randomisation. |
| Intervention type | Drug |
| Phase | Phase III |
| Drug / device / biological / vaccine name(s) | Amiodarone, atenolol, bisoprolol, carvedilol, metoprolol tartrate, propranolol, Betaloc [metoprolol tartrate], esmolol, labetalol, Rapibloc [landiolol hydrochloride] |
| Primary outcome measure(s) |
90-day mortality measured using patient records |
| Key secondary outcome measure(s) |
1. ICU and hospital mortality measured up to day 90 using patient's medical notes |
| Completion date | 31/12/2026 |
Eligibility
| Participant type(s) | Patient |
|---|---|
| Age group | Mixed |
| Lower age limit | 16 Years |
| Upper age limit | 120 Years |
| Sex | All |
| Target sample size at registration | 2560 |
| Key inclusion criteria | Current key inclusion criteria as of 15/06/2026: 1. Adult Patients (age ≥16 years) 2. Monitored in an area of higher care with the ability to deliver the interventions 3. Onset of NOAF or a new episode of AF during the acute illness (A&E, deterioration on ward, after surgery) where there is a clinical indication to treat with amiodarone or beta blockers as determined by the attending clinician/ACCP or equivalent. 4. Usual electrolyte management with potassium and magnesium has taken place according to site practice _____ Previous key inclusion criteria: 1. Patients in an adult ICU (age ≥16 years) 2. Onset of NOAF during the acute illness (A&E, deterioration on ward, after surgery) having previously been in sinus rhythm and not known to previously have had AF. 3. A minimum duration of AF of at least 30 minutes 4. Usual electrolyte management with potassium and magnesium according to site practice 5. A clinical indication to treat NOAF as determined by the attending clinician |
| Key exclusion criteria | Current key exclusion criteria as of 15/06/2026: 1. Treatment with anticoagulants or antiarrhythmics for the treatment of AF before the current hospital admission *anticoagulants or antiarrhythmics used for any other purpose can be included 2. Current concomitant medication that are contraindicated with the intervention or comparator medications (for example ciclosporin, itaconazole, letermovir) 3. Serum potassium of less than 4 mmol L-1 (measured either on point-of-care testing or laboratory) 4. Patients having undergone cardiac surgery during the current hospital admission, defined as any surgery including lung resections, stent procedures such as percutaneous coronary interventions or other angioplasty procedures done on the heart muscle, valves or thoracic arteries including the thoracic part of the aorta 5. Thyrotoxicosis 6. Withdrawal of life support therapy within 24 hours 7. Any other known contraindication or known sensitivity to beta-blockers or amiodarone 8. Known pregnancy or patients currently known to be breast-feeding _____ Previous key exclusion criteria: 1. Patients in receipt of amiodarone or a beta-blocker in the previous 24 hours 2. Patients receiving current concomitant medication with treatments that are contraindicated with the intervention/comparator medications 3. Patients with a serum potassium of <4 mmol L-1 4. Patients with a serum magnesium of <1.0 mmol L-1 5. Patients having undergone cardiac surgery during the current hospital admission, defined as any surgery including stent procedures such as percutaneous coronary interventions or other angioplasty procedures done on the heart muscle, valves or thoracic arteries including the thoracic part of the aorta 6. Patients with Thyrotoxicosis 7. Patients where there is a plan for withdrawal of life support therapy within 24 hours 8. Patients who have had other thoracic surgery that ingresses the thorax 9. Patients with any other known contraindication or known sensitivity to beta-blockers or amiodarone 10. Patients with a known pregnancy or patients currently known to be breastfeeding 11. Patients with any known previous documented history of AF, whether permanent, persistent or paroxysmal |
| Date of first enrolment | 08/05/2024 |
| Date of final enrolment | 30/06/2026 |
Locations
Countries of recruitment
- United Kingdom
- England
- Northern Ireland
- Scotland
- Wales
Study participating centres
Lincoln
LN2 5QY
England
Pond Street
London
NW3 2QG
England
Tooting
London
SW17 0QT
England
Taunton
TA1 5DA
England
Pinderfields General Hospital
Aberford Road
Wakefield
WF1 4EE
England
Sunderland
SR4 7TP
England
Watford
WD18 0HB
England
Kempston Road
Bedford
MK42 9DJ
England
Blackburn
BB2 3LR
England
Whinney Heys Road
Blackpool
FY3 8NR
England
Bournemouth
BH7 7DW
England
Longfleet Road
Poole
BH15 2JB
England
Minerva Road
Farnworth
Bolton
BL4 0JR
England
Duckworth Lane
Bradford
BD9 6RJ
England
Westbury-on-trym
Bristol
BS10 5NB
England
Anlaby Road
Hull
HU3 2JZ
England
Calow
Chesterfield
S44 5BL
England
Hollyhurst Road
Darlington
DL3 6HX
England
Larbert
FK5 4WR
Scotland
Bodelwyddan
Rhyl
LL18 5UJ
Wales
Birmingham
B9 5SS
England
Sutton Coldfield
B75 7RR
England
Hereford
HR1 2BN
England
Middlesbrough
TS4 3BW
England
Rothwell Road
Kettering
NN16 8UZ
England
London
SE5 9RS
England
Eccles
Salford
M6 8HD
England
Salford Royal
Stott Lane
Salford
M6 8HD
England
Fazakerley
Liverpool
L9 7LJ
England
Nethermayne
Basildon
SS16 5NL
England
Bath
BA1 3NG
England
Leeds General Infirmary
Great George Street
Leeds
LS1 3EX
England
Infirmary Square
Leicester
LE1 5WW
England
Crewe
CW1 4QJ
England
Luton
LU4 0DZ
England
Standing Way
Eaglestone
Milton Keynes
MK6 5NG
England
Southwick Hill Road
Cosham
Portsmouth
PO6 3LY
England
Oakwood
Moorgate Road
Rotherham
S60 2UD
England
Winchester
SO22 5DG
England
Basingstoke
RG24 9NA
England
Prescot Street
Liverpool
L7 8XP
England
Lyndon
West Bromwich
B71 4HJ
England
Tremona Road
Southampton
SO16 6YD
England
Newton Road
Torquay
TQ2 7AA
England
London
NW1 2PG
England
Edgbaston
Birmingham
B15 2TH
England
Lovely Lane
Warrington
WA5 1QG
England
Results and Publications
| Individual participant data (IPD) Intention to share | Yes |
|---|---|
| IPD sharing plan | The datasets generated during and/or analysed during the current study will be available upon request from the BCTU Data Sharing Committee following a formal Data Sharing Agreement (if applicable) email: abbrupt@trials.bham.ac.uk |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Protocol file | version 1.0 | 11/10/2023 | 10/05/2024 | No | No |
| Protocol file | version 4.0 | 20/01/2025 | 17/06/2025 | No | No |
| Study website | Study website | 11/11/2025 | 11/11/2025 | No | Yes |
Additional files
- ISRCTN59775011_PROTOCOL_V1.0_11Oct23.pdf
- Protocol file
- ISRCTN59775011_PROTOCOL_V4.0_20Jan25.pdf
- Protocol file
Editorial Notes
15/06/2026: The following changes were made to the study record:
1. The key inclusion criteria were changed.
2. The key exclusion criteria were changed.
18/06/2025: Contact details updated.
17/06/2025: The following changes were made to the study record:
1. The study participating centres were updated to remove East Surrey Hospital and Royal Sussex County Hospital and add Bedford Hospital, Blackburn Royal Infirmary, Blackpool Teaching Hospitals NHS Foundation Trust, Royal Bournemouth Hospital, Poole Hospital, Bolton NHS Foundation Trust, Bradford Teaching Hospitals NHS Foundation Trust, Southmead Hospital, Hull University Teaching Hospitals NHS Trust, Chesterfield Royal Hospital NHS Foundation Trust, Darlington Memorial Hospital NHS Trust, Forth Valley Royal Hospital, Glan Clwd Hospital, Birmingham Heartlands NHS Trust, Good Hope Hospital, County Hospital Hereford, County Hospital Hereford, James Cook University Hospital, Kettering General Hospital Laboratory, Kings College Hospital, Salford Hospital, Northern Care Alliance NHS Foundation Trust, Walton Centre NHS Foundation Trust, Basildon Hospital, Royal United Hospitals Bath NHS Foundation Trust, United Leeds Teaching Hospitals NHS Trust, University Hospitals of Leicester NHS Trust, Leighton Hospital, Luton & Dunstable Hospital, Milton Keynes Urgent Care Services Cic, Portsmouth Hospitals University NHS Trust, Rotherham General Hospital Laboratory, Royal Hampshire County Hospital, Basingstoke and North Hampshire Hospital, Royal Liverpool University Hospital NHS Trust, Sandwell General Hospital Laboratory, Southampton General Hospital, Torbay and South Devon NHS Foundation Trust, University College London Hospital, University Hospital Birmingham, Warrington and Halton Teaching Hospitals NHS Foundation Trust.
2. Protocol uploaded.
3. Sponsor details updated.
10/05/2024: Protocol uploaded. Sunderland Royal Hospital and Watford General Hospital were added to the study participating centres.
17/04/2024: The recruitment start date was changed from 01/04/2024 to 08/05/2024.
21/11/2023: Ethics approval added.
16/10/2023: The recruitment start date was changed from 01/10/2023 to 01/04/2024.
04/10/2023: Internal review.
14/09/2023: Trial's existence confirmed by NHS HRA.
