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

Area of Science:

• Cardiology
• Pharmacology
• Clinical Research

Background:

• Amiodarone is a highly effective antiarrhythmic drug (AAD) for managing atrial fibrillation (AF).
• However, amiodarone is associated with a significant incidence of adverse effects, necessitating careful consideration of its use.

Purpose of the Study:

• To analyze the patterns of amiodarone use in patients with AF within a real-world clinical setting.
• To investigate the variability of amiodarone prescription across different healthcare sites.
• To evaluate the association between amiodarone use and patient outcomes, including mortality, hospitalization, and stroke.

Main Methods:

• Utilized data from the ORBIT AF registry, analyzing patients on amiodarone at baseline, those starting it during follow-up, and those never on the drug.
• Employed hierarchical logistic regression to compare amiodarone use rates across 170 sites.
• Created propensity-matched cohorts to assess the association between amiodarone and outcomes using Cox proportional hazards modeling.

Main Results:

• A significant variation in amiodarone use was observed across sites, ranging from 3% to 21%.
• Among patients treated with amiodarone, 32% had contraindications or prior failures with other AADs.
• While baseline amiodarone use showed similar outcomes, incident amiodarone use was associated with a twofold increase in all-cause mortality.

Conclusions:

• Amiodarone use in community practice for AF is highly variable and often not aligned with guideline indications.
• A substantial proportion of patients treated with amiodarone could have been managed with alternative AADs.
• The findings highlight the need for more judicious and evidence-based prescribing of amiodarone in AF management.