Author + information
- Received April 19, 2011
- Revision received July 18, 2011
- Accepted July 26, 2011
- Published online November 1, 2011.
- Sanjeev Saksena, MD⁎,⁎ (, )
- April Slee, MS⁎,
- Albert L. Waldo, MD⁎,
- Nick Freemantle, PhD⁎,
- Mathew Reynolds, MD, MS⁎,
- Yves Rosenberg, MD†,
- Snehal Rathod, MS⁎,
- Shannon Grant, MS⁎,
- Elizabeth Thomas, MS⁎ and
- D. George Wyse, MD, PhD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Sanjeev Saksena, RWJ Medical School, Department of Medicine, 161 Washington Valley Road, Suite 201, Warren, New Jersey 07059
Objectives The impact of individual antiarrhythmic drugs (AADs) on mortality and hospital stay in atrial fibrillation (AF) was evaluated.
Background Cardiovascular (CV) outcomes in AF patients receiving pharmacologic rhythm control therapy have not been compared with rate control therapy on the basis of AAD selection.
Methods We compared CV outcomes in the AFFIRM (Atrial Fibrillation Follow-Up Investigation of Rhythm Management) trial in subgroups defined by the initial AAD selected with propensity score matched subgroups from the rate arm (Rate).
Results Seven hundred twenty-nine amiodarone patients, 606 sotalol patients, and 268 Class 1C patients were matched. The composite outcome of mortality or cardiovascular hospital stays (CVH) showed better outcomes with Rate compared with amiodarone (hazard ratio [HR]: 1.18, 95% confidence interval [CI]: 1.03 to 1.36, p = 0.02), sotalol (HR: 1.32, 95% CI: 1.13 to 1.54, p < 0.001), and Class 1C (HR: 1.22, 95% CI: 0.97 to 1.56, p = 0.10). There was a nonsignificant increase in mortality with amiodarone (HR: 1.20, 95% CI: 0.94 to 1.53, p = 0.15) with the risk of non-CV death being significantly higher with amiodarone versus Rate (HR: 1.11, 95% CI: 1.01 to 1.24, p = 0.04). First CVH event rates at 3 years were 47% for amiodarone, 50% for sotalol, and 44% for Class 1C versus 40%, 40%, and 36%, respectively, for Rate (amiodarone HR: 1.20, 95% CI: 1.03 to 1.40, p = 0.02, sotalol HR: 1.364, 95% CI: 1.16 to 1.611, p < 0.001, Class 1C HR: 1.24, 95% CI: 0.96 to 1.60, p = 0.09). Time to CVH with intensive care unit stay or death was shorter with amiodarone (HR: 1.22, 95% CI: 1.02 to 1.46, p = 0.03).
Conclusions In AFFIRM, composite mortality and CVH outcomes differed for Rate and AADs due to differences in CVH; CVH event rates during follow-up were high for all cohorts, but they were higher for all groups on AADs. Death, intensive care unit hospital stay, and non-CV death were more frequent with amiodarone. (Atrial Fibrillation Follow-Up Investigation of Rhythm Management; NCT00000556)
- antiarrhythmic drugs
- atrial fibrillation
- cardiovascular hospitalizations
- cardiovascular outcomes
- clinical trials
- outcomes research
Dr. Saksena is or has been a consultant, investigator, and research grant recipient for the National Heart Lung and Blood Institute, Medtronic Inc., St. Jude Medical Inc., Sanofi-Aventis, Sorin Group, and Aryx Pharmaceuticals; and has been a Speakers' Bureau member for Sanofi-Aventis. Dr. Waldo is a consultant to Sanofi-Aventis, Ortho-McNeil-Janssen, Biotronik, St. Jude Medical, Daiichi, Sankyo Pharmaceuticals, Medtronic Inc., Astellas Pharma, Biosense Webster Inc., Bristol-Myers Squibb, Portola, Boehringer Ingelheim, CardioInsight Technologies, Merck, AtriCure Inc., and Sanofi-Aventis; and is a speaker for Sanofi-Aventis. Dr. Freemantle is a consultant for Sanofi-Aventis, Merck, Pfizer, Eli Lilly, Novo Nordisk, and Medtronic. Dr. Reynolds has received a research grant and is a consultant/advisory board member for Sanofi-Aventis. Dr. Wyse is a consultant to Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, Sanofi-Aventis, Biotronik, Boston Scientific/Guidant, National Heart, Lung and Blood Institute, Duke Clinical Research Institute, European Commission, Merck, Medtronic, and Bayer, and Speakers' Bureau member for Sanofi-Aventis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. For list of investigators and affiliated institutions, please see the Online Appendix.
- Received April 19, 2011.
- Revision received July 18, 2011.
- Accepted July 26, 2011.
- American College of Cardiology Foundation