Antiarrhythmic drug use was not independently associated with all-cause mortality or cardiovascular events (492 total deaths, 548 total events) compared to no AADs over a median 502 days.
Cohort (n=4,244)
Yes
Does the use of antiarrhythmic drugs reduce all-cause mortality or cardiovascular events in atrial fibrillation patients aged ≥80 years?
In atrial fibrillation patients aged 80 and older, antiarrhythmic drugs are not independently associated with improved mortality or cardiovascular outcomes, suggesting pharmacological rhythm control should be reserved for highly selected cases.
Abstract Background Evidence on antiarrhythmic drugs (AADs) in the oldest atrial fibrillation (AF) patients is limited. We investigated clinical characteristics and outcomes associated with AADs use in this population. Methods The oldest (age ≥ 80 years) AF patients from the nationwide START registry were included. Patients were divided into three groups: no AADs (n = 3573), class 1c-AADs (n = 207) and Amiodarone (n = 464). Factors associated with AADs were evaluated using multivariable logistic regression models. The associations between AADs and all-cause mortality were assessed using Cox proportional hazards models and cardiovascular events (CVEs) were analysed using Fine-Gray competing risk models. Results Among 4244 patients (54.9% women), the mean age was 84.8 ± 3.8 years. AADs were prescribed in 671 patients (15.8%), including amiodarone in 464 (10.9%) and 1c-AADs in 207 (4.9%). 1c-AADs use was associated with younger age and fewer comorbidities, including lower prevalence of diabetes, heart failure, chronic obstructive pulmonary disease/obstructive sleep apnoea and better functional and social status. Amiodarone use was associated with coronary artery disease and markers of frailty. Over a median follow-up of 502 (interquartile range 362–857) days, 492 deaths and 548 CVEs occurred. In unadjusted analyses, 1c-AADs were associated with lower all-cause mortality and CVEs; however, these associations were no longer significant after multivariable adjustment. Amiodarone use was not associated with clinical outcomes in either unadjusted or adjusted analyses. Conclusion In the oldest AF patients, AADs use is influenced by comorbidity burden and frailty-related characteristics. AADs were not independently associated with mortality or CVEs, suggesting that pharmacological rhythm control may be reserved for selected cases in this population.
Menichelli et al. (Fri,) conducted a cohort in Atrial fibrillation (n=4,244). Antiarrhythmic drugs (class 1c-AADs and amiodarone) vs. No antiarrhythmic drugs was evaluated on All-cause mortality and cardiovascular events. Antiarrhythmic drug use was not independently associated with all-cause mortality or cardiovascular events (492 total deaths, 548 total events) compared to no AADs over a median 502 days.