TY - JOUR

T1 - Antiarrhythmic therapy and risk of death in patients with atrial fibrillation: a nationwide study

AU - Andersen, Søren Skøtt

AU - Hansen, Morten Lock

AU - Gislason, Gunnar H

AU - Schramm, Tina Ken

AU - Folke, Fredrik

AU - Fosbøl, Emil

AU - Abildstrøm, Steen Z

AU - Madsen, Mette

AU - Køber, Lars

AU - Torp-Pedersen, Christian

AU - Andersen, Søren Skøtt

AU - Hansen, Morten Lock

AU - Gislason, Gunnar H

AU - Schramm, Tina Ken

AU - Folke, Fredrik

AU - Fosbøl, Emil

AU - Abildstrøm, Steen Z

AU - Madsen, Mette

AU - Køber, Lars

AU - Torp-Pedersen, Christian

N1 - Keywords: Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Cohort Studies; Denmark; Female; Humans; Incidence; Male; Middle Aged; Proportional Hazards Models; Registries; Risk Assessment; Risk Factors; Survival Analysis; Survival Rate; Treatment Outcome

PY - 2009

Y1 - 2009

N2 - 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.

AB - 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.

U2 - 10.1093/europace/eup119

DO - 10.1093/europace/eup119

M3 - Journal article

C2 - 19443433

VL - 11

SP - 886

EP - 891

JO - Europace

JF - Europace

SN - 1099-5129

IS - 7

ER -