Key result
Antiarrhythmic therapy with flecainide, propafenone, sotalol, or amiodarone was not associated with increased risk of death in patients with atrial fibrillation (HRs ranging from 0.38 to 0.94).
Why the study?
Does antiarrhythmic drug therapy affect the risk of death in patients with atrial fibrillation?
Cohort (n=141,500)
Yes
Does antiarrhythmic drug therapy affect the risk of death in patients with atrial fibrillation?
Effect estimate: HR 0.38, 0.65, 0.65, and 0.94 (95% CI 0.32-0.44, 0.58-0.71, 0.63-0.67, and 0.89-1.00)
In a nationwide Danish cohort, the use of antiarrhythmic drugs for atrial fibrillation was not associated with an increased risk of death, suggesting appropriate patient selection in clinical practice.
Reassures on mortality risk with these agents in AF; leaves open confirmation via randomized trials.
AIMS: To examine the risk of death associated with antiarrhythmic drug (AAD) therapy in a nationwide unselected cohort of patients with atrial fibrillation (AF). METHODS AND RESULTS: All patients admitted with AF in Denmark from 1995 to 2004 and their subsequent use of AADs were identified by individual-level linkage of nationwide registries. Multivariable Cox proportional-hazard models with time-dependent covariates were used to analyse the risk of death associated with AAD therapy. A total of 141,500 patients were included in the study; of these 3356 (2.4%) patients received treatment with flecainide, 3745 (2.6%) propafenone, 23,346 (16.5%) sotalol, and 10,376 (7.3%) amiodarone. Annualized mortality rates were 2.54, 4.25, 5.29, and 7.42 per year per 100 person years for flecainide, propafenone, sotalol, and amiodarone, respectively. Multivariable Cox proportional-hazard models did not show increased risk of death associated with any of the AADs. Hazard ratio (95% confidence interval) for flecainide 0.38 (0.32-0.44), propafenone 0.65 (0.58-0.71), sotalol 0.65 (0.63-0.67), and amiodarone 0.94 (0.89-1.00). CONCLUSION: In an unselected cohort of patients with AF, antiarrhythmic treatment with flecainide, propafenone, sotalol, or amiodarone was not associated with increased risk of death. From a safety perspective, this indicates appropriate selection of patients for AAD therapy.
No takes yet. Share an insight, caveat, or question.
Andersen et al. (2009) conducted a cohort in Atrial fibrillation (n=141,500). Antiarrhythmic drugs (flecainide, propafenone, sotalol, amiodarone) vs. Non-users was evaluated on Risk of death (HR 0.38, 0.65, 0.65, and 0.94, 95% CI 0.32-0.44, 0.58-0.71, 0.63-0.67, and 0.89-1.00). Antiarrhythmic therapy with flecainide, propafenone, sotalol, or amiodarone was not associated with increased risk of death in patients with atrial fibrillation (HRs ranging from 0.38 to 0.94).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: