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Patterns of amiodarone use and outcomes in clinical practice for atrial fibrillation

American Heart Journal Dec 13, 2019

Pokorney SD, Holmes DN, Shrader P, et al. - Given amiodarone has a high incidence of adverse effects, researchers investigated the proportion of atrial fibrillation (AF) cases managed with a guideline-based indication for amiodarone, the variability in amiodarone use across sites, as well as the outcomes (mortality, hospitalization, and stroke) in patients who received amiodarone and were included in this study utilizing the ORBIT AF registry. They examined patients with AF receiving amiodarone at enrollment, prescribed amiodarone during follow-up, or never on amiodarone. Of 6,987 AF patients, 867 (12%) were taking amiodarone at baseline and 451 (6%) commenced on incident amiodarone during the 3-year observation period. They noted variable use of amiodarone amongst sites, from 3% in the lowest tertile to 21% in the highest. Contraindications to other antiarrhythmic drugs (AADs) or having failed another AAD in the past were reported in 32% among those treated. A similarity was noted in mortality, cardiovascular hospitalization, and stroke among matched patients on and not on amiodarone at baseline, while higher all-cause mortality was observed in relation to incident amiodarone use in matched patients. Findings revealed highly variable amiodarone use in AF patients in community practice. More than 2 out of 3 patients managed with amiodarone seemed to be eligible for a different AAD.
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