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—I appreciate Dr Rimm's criticisms and concerns. As he points out, we did not consider the prevalence of alcoholism in a control group of patients visiting the Denver General Hospital emergency room. Indeed, as stated in our discussion, "Ours was not a case-control study." Equally important, in our study, atrial fibrillation was attributed to alcohol intoxication only if the patient was acutely intoxicated. In contrast, the other articles referred to in Dr Rimm's letter (by Nolan Barchha et al, and Green) did not consider acute alcohol intoxication as implied. These authors reported a high prevalence of chronic alcoholism among general medical patients; in all three studies alcoholism was defined as problem drinking, social maladjustment, and/or a history of alcohol-related, chronic medical conditions. In the words of Roch (one of the earliest to investigate the importance of alcoholism among general medical patients, and quoted in the article by Nolan),
Lowenstein SR. Atrial Fibrillation-Reply. Arch Intern Med. 1984;144(9):1889. doi:10.1001/archinte.1984.00350210218048