Guideline-Concordant Antiarrhythmic Drug Use in the Get With The Guidelines-Atrial Fibrillation Registry

Area of Science:

• Cardiology
• Pharmacology
• Health Services Research

Background:

• Antiarrhythmic drug (AAD) therapy for atrial fibrillation (AF) carries risks of proarrhythmia and toxicity.
• Current practice guidelines recommend individualized AAD selection based on patient factors to minimize adverse events.
• Real-world prescription patterns and guideline adherence for AADs in AF are not well understood.

Purpose of the Study:

• To evaluate current prescription patterns of AADs in patients with AF.
• To assess the degree of guideline-concordant AAD use in clinical practice.
• To identify variations in AAD prescribing based on patient, hospital, and regional characteristics.

Main Methods:

• Analysis of 21,921 patients with AF discharged on an AAD from the Get With The Guidelines-Atrial Fibrillation registry (2014-2018).
• Classification of AAD use as guideline-concordant or non-concordant based on established criteria.
• Examination of prescription rates and guideline concordance across different AADs, patient subgroups, and hospital/geographic regions.

Main Results:

• Amiodarone was the most frequently prescribed AAD (38%), followed by sotalol (23.2%) and dofetilide (19.2%).
• Overall guideline-concordant AAD prescription at discharge was 84%, with notable variations by drug (dofetilide 93% to propafenone 48%).
• Significant variability in guideline-concordant AAD use was observed across different hospitals and geographic regions.

Conclusions:

• Amiodarone, sotalol, and dofetilide remain the most common AADs for AF management.
• While overall guideline-concordant AAD use is high, significant regional and hospital-level variations exist.
• These findings highlight opportunities for targeted quality improvement initiatives to optimize AAD therapy in AF.