The evolving landscape of oral anti-arrhythmic prescriptions for atrial fibrillation in England: 1998–2014

AIMS: An important decision in the management of patients with atrial fibrillation is whether to adopt a rate or rhythm control strategy. Options for the latter include oral membrane-active anti-arrhythmic drugs (AADs) or catheter ablation. Recent prescription trends may have been affected by the introduction of dronedarone and an increasing number of reports suggesting increased mortality in those taking AADs. We describe the trend in oral AAD prescriptions in England in the period 1998-2014. METHODS AND RESULTS: We conducted a retrospective study using data from the Prescription Cost Analysis system, which holds information on every prescription dispensed in the community in England. We obtained data from 1998 to October 2014 for all Class Ia, Ic, and III AADs. Amiodarone and sotalol remain the most commonly prescribed AADs in England, though the use of both is decreasing. There has been a linear increase in the uptake of flecainide. Dronedarone prescriptions peaked in 2011, and our most recent data show that amiodarone prescriptions are 25-fold those of dronedarone. CONCLUSION: There is a decline in the use of amiodarone and sotalol consistent with the growing safety concerns with these drugs along with neutral results from landmark trials comparing rate and rhythm control. Dronedarone has failed to make an impact on AAD prescribing. In contrast, flecainide has seen an increase in use during the study period.