TY - JOUR
T1 - Patterns of amiodarone use and outcomes in clinical practice for atrial fibrillation
AU - Pokorney, Sean D.
AU - Holmes, Da Juanicia N.
AU - Shrader, Peter
AU - Thomas, Laine
AU - Fonarow, Gregg C.
AU - Mahaffey, Kenneth W.
AU - Gersh, Bernard J.
AU - Kowey, Peter R.
AU - Naccarelli, Gerald V.
AU - Freeman, James V.
AU - Singer, Daniel E.
AU - Washam, Jeffrey B.
AU - Peterson, Eric D.
AU - Piccini, Jonathan P.
AU - Reiffel, James A.
N1 - Funding Information:
SDP reports modest research grant support from Gilead, Boston Scientific, Bristol-Myers Squibb, Pfizer, ad Janssen Pharmaceuticals; significant research grant support from the Food and Drug Administration; modest consulting support from Boston Scientific, Medtronic, Bristol-Myers Squibb, Pfizer, and Portola. Ms Holmes, Mr Shrader, Dr Thomas, Dr Singer, and Dr Washam report no disclosures. Dr Fonarow reports modest Consultant/Advisory Board support from Ortho McNeil. Dr Mahaffey reports research support from Afferent, Amgen, Apple, AstraZeneca, Cardiva Medical, Inc., Daiichi, Ferrings, Google (Verily), Johnson & Johnson, Luitpold, Medtronic, Merck, Novartis, Sanofi, St Jude, and Tenas; consulting to Ablynx, AstraZeneca, Boehringer Ingelheim, Bristol Meyers Squibb, Cardiometabolic Health Congress, Elsevier, Glaxo Smith Kline, Johnson & Johnson, Mederg, Medscape, Merck, Mitsubishi, Myokaria, Novartis, Oculeve, Portola, Radiometer, Springer Publishing, Theravance, UCSF, and WebMD; and equity in BioPrint Fitness. Dr Gersh reports modest DSMB/Advisory Board support from Medtronic, Baxter Healthcare Corporation, InspireMD, Cardiovascular Research Foundation, PPD Development, LP, Boston Scientific, and St. Jude. Dr Kowey reports modest Consultant/Advisory Board support from Boehringer Ingelheim, Bristol-Myers Squibb, Johnson & Johnson, Portola, Merck, Sanofi, and Daiichi Sankyo. Dr Naccarelli reports research support from Janssen and service as consultant to Glaxo-Smith-Kline, Janssen, and Daiichi-Sankyo. Dr Freeman has acted as a consultant and advisory board member for Janssen Scientific; he also reports personal fees from Janssen Pharmaceuticals and the American College of Cardiology National Cardiovascular Data Registry outside the submitted work. Dr Peterson reports significant research grant support from Eli Lilly & Company, Janssen Pharmaceuticals, Inc, and the American Heart Association; modest Consultant/Advisory Board support from Boehringer Ingelheim, Bristol-Myers Squibb, Janssen Pharmaceuticals, Inc, Pfizer, and Genentech Inc. Dr Piccini reports significant research grant support from Johnson & Johnson/Janssen Pharmaceuticals; significant other research support from Bayer HealthCare Pharmaceuticals Inc (formerly Berlex Labs), Boston Scientific Corporation, Johnson & Johnson Pharmaceutical Research & Development; modest Consultant/Advisory Board support from Forest Laboratories, Inc and Medtronic, Inc; and significant Consultant/Advisory Board support from Johnson & Johnson/Janssen Pharmaceuticals. Dr Reiffel reports research support from Janssen and Medtronic; was a consultant to Medtronic, Janssen, In Cardia Therapeutics, Acesion, Portola; and speaker's bureau activities with Janssen and Boehringer Ingelheim. Appendix A
Funding Information:
None. The ORBIT-AF registry is sponsored by Janssen Scientific Affairs, LLC, Raritan, NJ. SDP reports modest research grant support from Gilead, Boston Scientific, Bristol-Myers Squibb, Pfizer, ad Janssen Pharmaceuticals; significant research grant support from the Food and Drug Administration; modest consulting support from Boston Scientific, Medtronic, Bristol-Myers Squibb, Pfizer, and Portola. Ms Holmes, Mr Shrader, Dr Thomas, Dr Singer, and Dr Washam report no disclosures. Dr Fonarow reports modest Consultant/Advisory Board support from Ortho McNeil. Dr Mahaffey reports research support from Afferent, Amgen, Apple, AstraZeneca, Cardiva Medical, Inc. Daiichi, Ferrings, Google (Verily), Johnson & Johnson, Luitpold, Medtronic, Merck, Novartis, Sanofi, St Jude, and Tenas; consulting to Ablynx, AstraZeneca, Boehringer Ingelheim, Bristol Meyers Squibb, Cardiometabolic Health Congress, Elsevier, Glaxo Smith Kline, Johnson & Johnson, Mederg, Medscape, Merck, Mitsubishi, Myokaria, Novartis, Oculeve, Portola, Radiometer, Springer Publishing, Theravance, UCSF, and WebMD; and equity in BioPrint Fitness. Dr Gersh reports modest DSMB/Advisory Board support from Medtronic, Baxter Healthcare Corporation, InspireMD, Cardiovascular Research Foundation, PPD Development, LP, Boston Scientific, and St. Jude. Dr Kowey reports modest Consultant/Advisory Board support from Boehringer Ingelheim, Bristol-Myers Squibb, Johnson & Johnson, Portola, Merck, Sanofi, and Daiichi Sankyo. Dr Naccarelli reports research support from Janssen and service as consultant to Glaxo-Smith-Kline, Janssen, and Daiichi-Sankyo. Dr Freeman has acted as a consultant and advisory board member for Janssen Scientific; he also reports personal fees from Janssen Pharmaceuticals and the American College of Cardiology National Cardiovascular Data Registry outside the submitted work. Dr Peterson reports significant research grant support from Eli Lilly & Company, Janssen Pharmaceuticals, Inc, and the American Heart Association; modest Consultant/Advisory Board support from Boehringer Ingelheim, Bristol-Myers Squibb, Janssen Pharmaceuticals, Inc, Pfizer, and Genentech Inc. Dr Piccini reports significant research grant support from Johnson & Johnson/Janssen Pharmaceuticals; significant other research support from Bayer HealthCare Pharmaceuticals Inc (formerly Berlex Labs), Boston Scientific Corporation, Johnson & Johnson Pharmaceutical Research & Development; modest Consultant/Advisory Board support from Forest Laboratories, Inc and Medtronic, Inc; and significant Consultant/Advisory Board support from Johnson & Johnson/Janssen Pharmaceuticals. Dr Reiffel reports research support from Janssen and Medtronic; was a consultant to Medtronic, Janssen, In Cardia Therapeutics, Acesion, Portola; and speaker's bureau activities with Janssen and Boehringer Ingelheim.
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2020/2
Y1 - 2020/2
N2 - Background: Amiodarone is the most effective antiarrhythmic drug (AAD) for atrial fibrillation (AF), but it has a high incidence of adverse effects. Methods: Using the ORBIT AF registry, patients with AF on amiodarone at enrollment, prescribed amiodarone during follow-up, or never on amiodarone were analyzed for the proportion treated with a guideline-based indication for amiodarone, the variability in amiodarone use across sites, and the outcomes (mortality, hospitalization, and stroke) among patients treated with amiodarone. Hierarchical logistic regression modeling with site-specific random intercepts compared rates of amiodarone use across 170 sites. A logistic regression model for propensity to receive amiodarone created a propensity-matched cohort. Cox proportional hazards modeling, stratified by matched pairs evaluated the association between amiodarone and outcomes. Results: Among 6,987 AF patients, 867 (12%) were on amiodarone at baseline and 451 (6%) started on incident amiodarone during the 3-year follow-up. Use of amiodarone varied among sites from 3% in the lowest tertile to 21% in the highest (p<0.0001). Among those treated, 32% had documented contraindications to other AADs or had failed another AAD in the past. Mortality, cardiovascular hospitalization, and stroke were similar among matched patients on and not on amiodarone at baseline, while incident amiodarone use in matched patients was associated with higher all-cause mortality (adjusted HR 2.06, 95% CI 1.35-3.16). Conclusions: Use of amiodarone among AF patients in community practice is highly variable. More than 2 out of 3 patients treated with amiodarone appeared to be eligible for a different AAD.
AB - Background: Amiodarone is the most effective antiarrhythmic drug (AAD) for atrial fibrillation (AF), but it has a high incidence of adverse effects. Methods: Using the ORBIT AF registry, patients with AF on amiodarone at enrollment, prescribed amiodarone during follow-up, or never on amiodarone were analyzed for the proportion treated with a guideline-based indication for amiodarone, the variability in amiodarone use across sites, and the outcomes (mortality, hospitalization, and stroke) among patients treated with amiodarone. Hierarchical logistic regression modeling with site-specific random intercepts compared rates of amiodarone use across 170 sites. A logistic regression model for propensity to receive amiodarone created a propensity-matched cohort. Cox proportional hazards modeling, stratified by matched pairs evaluated the association between amiodarone and outcomes. Results: Among 6,987 AF patients, 867 (12%) were on amiodarone at baseline and 451 (6%) started on incident amiodarone during the 3-year follow-up. Use of amiodarone varied among sites from 3% in the lowest tertile to 21% in the highest (p<0.0001). Among those treated, 32% had documented contraindications to other AADs or had failed another AAD in the past. Mortality, cardiovascular hospitalization, and stroke were similar among matched patients on and not on amiodarone at baseline, while incident amiodarone use in matched patients was associated with higher all-cause mortality (adjusted HR 2.06, 95% CI 1.35-3.16). Conclusions: Use of amiodarone among AF patients in community practice is highly variable. More than 2 out of 3 patients treated with amiodarone appeared to be eligible for a different AAD.
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UR - http://www.scopus.com/inward/citedby.url?scp=85076057312&partnerID=8YFLogxK
U2 - 10.1016/j.ahj.2019.09.017
DO - 10.1016/j.ahj.2019.09.017
M3 - Article
C2 - 31812756
AN - SCOPUS:85076057312
SN - 0002-8703
VL - 220
SP - 145
EP - 154
JO - American Heart Journal
JF - American Heart Journal
ER -