Abstract 18735: Impact of Pulmonary Disease on Clinical Outcomes With Atrial Fibrillation Treatment Strategies: Is Amiodarone Contraindicated?
Background: Specific co-morbidiities may identify atrial fibrillation (AF) subpopulations that may impact on clinical outcomes in AF and application of individual treatment strategies.
Methods: We examined a composite mortality(D) & cardiovascular hospitalization (CVH) endpoint to compare clinical outcomes with amiodarone as primary therapy (Amio) to either other rhythm therapy (OR) or rate control (Rate) in patients with or without concomitant pulmonary (PD) disease in the AFFIRM trial.
Results: Amio pts (n=735) were compared to OR (n=1298) & Rate (n=2027) cohorts. 133 pts (18.1 %) with Amio. 178 pts (13.7%) with OR & 280 pts (13.8%) with Rate had PD identified (p=.011). PD pts more often had associated with CAD, angina, and heart failure. After adjusting for covariates and treatment strategy, PD was a significant predictor of worse composite outcome (HR=1.34, p<.0001), increased D & CVH but choice of treatment strategy did not affect D (p=0.34). PD was associated with increased CVH length of stay (LOS,p<.004) but this also did not differ between Amio, Rate or OR for LOS or acuity of care. In pts without PD, Rate control was superior to Amio (HR=1.27, p=.0003) and OR (HR=1.41, p<.0001) (Figure). After adjustment for baseline imbalances, Rate control was still superior to Amio and OR (HR=1.2 and 1.5 respectively, p=.0012 and <.0001) and OR was inferior to Amio (HR=1.2, p=.008).
Conclusions: 1. Presence of PD confers worse CVH outcomes in AF pts. 2. Amio does not confer independent risk of adverse CVH outcomes in AF pts with PD but has no discernable advantage over Rate.
- © 2010 by American Heart Association, Inc.