In elderly AF patients on anticoagulants, neither class 1c AADs nor amiodarone significantly reduced mortality or cardiovascular events in multivariate analysis.
Do antiarrhythmic drugs (class 1c or amiodarone) reduce mortality or cardiovascular events in elderly patients (≥80 years) with nonvalvular atrial fibrillation on oral anticoagulation?
In patients aged ≥80 years with atrial fibrillation, the use of class 1c antiarrhythmic drugs or amiodarone does not significantly reduce the risk of mortality or cardiovascular events.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Atrial fibrillation (AF) is a common arrhythmia among elderly patients; however, data on the use of antiarrhythmic drugs (AAD) in this population are limited. The aim of our study is to evaluate the characteristics of patients treated with AAD and the association with cardiovascular events and all-cause mortality in the elderly population aged ≥80 years with AF on oral anticoagulant therapy. Methods 4,244 patients with AF and age ≥80 years were included from the Italian START registry. Patients were stratified according to AAD use into 3 groups: 1) no AAD (n = 3,573), 2) AAD class 1c (n = 207) and 3) amiodarone (n = 464). Baseline characteristics, comorbidities and therapies were compared between the groups. Cox logistic regression models were used to determine the association between AAD use, mortality and cardiovascular events, and results were expressed as Hazard Ratio (HR) with relative 95% confidence interval (95%CI). Results The mean age of the study population was 84.8±3.8 years and 54.9% were women. 3,573 patients were not taking antiarrhythmic therapy, 207 were treated with AAD class 1c and 464 with amiodarone. Patients treated with AAD class 1c had a higher prevalence of paroxysmal AF (62.7% vs 44.5%, p0.001) and renal failure (28.2% vs 13.1%, p0.001) than patients treated with amiodarone. On the other hand, the population using amiodarone had comorbidities such as coronary artery disease more frequently (23.3% vs 9.7%, p0.001) than patients treated with AAD-1c. During a follow-up period of 685.6±537.7 days, there were 492 deaths and 548 cardiovascular events. The univariate Cox regression analysis showed that class 1c AADs were associated with a lower risk of all-cause mortality (HR: 0.371, 95%CI: 0.191-0.717, p=0.003) and cardiovascular events (HR: 0.443, 95%CI: 0.250-0.786, p=0.005) compared to the population not using AADs. However, these associations were not confirmed on multivariate analysis where neither class 1c AADs nor amiodarone were significantly associated with increased mortality (HR: 0.643, 95% CI: 0.327-1.264, p=0. 200 for AAD class 1c and HR: 1.118, 95% CI 0.835-1.496, p=0.453 for amiodarone) and cardiovascular events (HR: 0.703 95% CI: 0.390-1.265, p=0.239 for AAD class 1c and HR: 1.027, 95% CI: 0.774-1.361, p=0.856 for amiodarone). Conclusions In elderly patients with AF, the use of class 1c AADs and amiodarone is not associated with a reduction in the risk of mortality or cardiovascular events, therefore long-term treatment with these drugs should be carefully evaluated in the individual patient weighing up the risks and benefits.
Carlo et al. (Sat,) reported a other. In elderly AF patients on anticoagulants, neither class 1c AADs nor amiodarone significantly reduced mortality or cardiovascular events in multivariate analysis.