TY - JOUR
T1 - Use of antiarrhythmic drug therapy and clinical outcomes in older patients with concomitant atrial fibrillation and coronary artery disease
AU - Steinberg, Benjamin A.
AU - Broderick, Samuel H.
AU - Lopes, Renato D.
AU - Shaw, Linda K.
AU - Thomas, Kevin L.
AU - DeWald, Tracy A.
AU - Daubert, James P.
AU - Peterson, Eric D.
AU - Granger, Christopher B.
AU - Piccini, Jonathan P.
PY - 2014/9
Y1 - 2014/9
N2 - Aims: Atrial fibrillation (AF) and coronary artery disease (CAD) are common in older patients. We aimed to describe the use of antiarrhythmic drug (AAD) therapy and clinical outcomes in these patients. Methods and results: We analysed AAD therapy and outcomes in 1738 older patients (age ≥ 65) with AF and CAD in the Duke Databank for cardiovascular disease. The primary outcomes were mortality and rehospitalization at 1 and 5 years. Overall, 35% of patients received an AAD at baseline, 43% were female and 85% were white. Prior myocardial infarction (MI, 31%) and heart failure (41%) were common. Amiodarone was the most common AAD (21%), followed by pure Class III agents (sotalol 6.3%, dofetilide 2.2%). Persistence of AAD was low (35% at 1 year). After adjustment, baseline AAD use was not associated with 1-year mortality [adjusted hazard ratio (HR) 1.23, 95%confidence interval (CI) 0.94-1.60] or cardiovascular mortality (adjusted HR 1.27, 95% CI 0.90-1.80). However, AAD use was associated with increased all-cause rehospitalization (adjusted HR 1.20, 95% CI 1.03-1.39) and cardiovascular rehospitalization (adjusted HR 1.20, 95% CI 1.01-1.43) at 1 year. This association did not persist at 5 years; however, these patients were at very high risk of death (55% for those > 75 and on AAD) and all-cause rehospitalization (87% for those > 75 and on AAD) at 5 years. Conclusions: In older patients with AF and CAD, antiarrhythmic therapy was associated with increased rehospitalization at 1 year. Overall, these patients are at high risk of longer-term hospitalization and death. Safer, better-tolerated, and more effective therapies for symptom control in this high-risk population are warranted. All rights reserved. & The Author 2014.
AB - Aims: Atrial fibrillation (AF) and coronary artery disease (CAD) are common in older patients. We aimed to describe the use of antiarrhythmic drug (AAD) therapy and clinical outcomes in these patients. Methods and results: We analysed AAD therapy and outcomes in 1738 older patients (age ≥ 65) with AF and CAD in the Duke Databank for cardiovascular disease. The primary outcomes were mortality and rehospitalization at 1 and 5 years. Overall, 35% of patients received an AAD at baseline, 43% were female and 85% were white. Prior myocardial infarction (MI, 31%) and heart failure (41%) were common. Amiodarone was the most common AAD (21%), followed by pure Class III agents (sotalol 6.3%, dofetilide 2.2%). Persistence of AAD was low (35% at 1 year). After adjustment, baseline AAD use was not associated with 1-year mortality [adjusted hazard ratio (HR) 1.23, 95%confidence interval (CI) 0.94-1.60] or cardiovascular mortality (adjusted HR 1.27, 95% CI 0.90-1.80). However, AAD use was associated with increased all-cause rehospitalization (adjusted HR 1.20, 95% CI 1.03-1.39) and cardiovascular rehospitalization (adjusted HR 1.20, 95% CI 1.01-1.43) at 1 year. This association did not persist at 5 years; however, these patients were at very high risk of death (55% for those > 75 and on AAD) and all-cause rehospitalization (87% for those > 75 and on AAD) at 5 years. Conclusions: In older patients with AF and CAD, antiarrhythmic therapy was associated with increased rehospitalization at 1 year. Overall, these patients are at high risk of longer-term hospitalization and death. Safer, better-tolerated, and more effective therapies for symptom control in this high-risk population are warranted. All rights reserved. & The Author 2014.
KW - Antiarrhythmic drug
KW - Atrial fibrillation
KW - Elderly
KW - Ischaemic heart disease
KW - Outcomes research
UR - http://www.scopus.com/inward/record.url?scp=84906977752&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84906977752&partnerID=8YFLogxK
U2 - 10.1093/europace/euu077
DO - 10.1093/europace/euu077
M3 - Article
C2 - 24755440
AN - SCOPUS:84906977752
SN - 1099-5129
VL - 16
SP - 1284
EP - 1290
JO - Europace
JF - Europace
IS - 9
ER -