Key result
Dronedarone directionally reduced rates of death, cardiovascular hospitalization, and HF hospitalization compared to placebo in AF/AFL patients with HFpEF and HFmrEF, though not significant.
Why the study?
Limited therapeutic options exist for AF/AFL with concomitant HFpEF and HFmrEF, and sparse data examine dronedarone's role in this population.
Does dronedarone reduce cardiovascular events in patients with paroxysmal or persistent AF/AFL and concomitant HFpEF or HFmrEF?
RCT
Does dronedarone reduce cardiovascular events in patients with paroxysmal or persistent AF/AFL and concomitant HFpEF or HFmrEF?
Dronedarone directionally reduces cardiovascular events in patients with AF/AFL and HFpEF/HFmrEF, though findings from this post-hoc analysis were not statistically significant and require confirmation in a dedicated trial.
Answers are grounded in this paper and cite their sources.
No practice change for dronedarone in AF/AFL with HFpEF/HFmrEF; post-hoc data leave efficacy open for dedicated trials.
AIMS: Limited therapeutic options are available for the management of atrial fibrillation/flutter (AF/AFL) with concomitant heart failure (HF) with preserved (HFpEF) and mildly reduced ejection fraction (HFmrEF). Dronedarone reduces the risk of cardiovascular events in patients with AF, but sparse data are available examining its role in patients with AF complicated by HFpEF and HFmrEF. METHODS AND Rates of death, cardiovascular hospitalization, and HF hospitalization each directionally favoured dronedarone versus placebo in HFpEF and HFmrEF, but these treatment effects were not statistically significant in this subgroup. CONCLUSIONS: Dronedarone is associated with reduced cardiovascular events in patients with paroxysmal or persistent AF/AFL and HF across the spectrum of LVEF, including among those with HFpEF and HFmrEF. These data support a rationale for a future dedicated and powered clinical trial to affirm the net clinical benefit of dronedarone in this population.
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Vaduganathan et al. (2022) conducted an RCT in Atrial fibrillation/flutter with concomitant heart failure with preserved and mildly reduced ejection fraction. Dronedarone vs. Placebo was evaluated on Death, cardiovascular hospitalization, and HF hospitalization (p=0.71). Dronedarone directionally reduced rates of death, cardiovascular hospitalization, and HF hospitalization compared to placebo in AF/AFL patients with HFpEF and HFmrEF, though not significant.
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