Abstract 17244: Is Selection of Antiarrhythmic Drugs for Atrial Fibrillation Consistent with Guideline Recommendations: Results from a Large Contemporary Community Cohort
Objective: Guidelines for atrial fibrillation (AF) management give tiered recommendations for the selection of antiarrhythmic drugs (AAD). We explored AAD use from February 2006 through December 2010 in non-Medicare AF patients in clinical practice and assessed consistency with guideline recommendations.
Methods: Using the Thomas Reuters MarketScan© database of commercial health claims, patients > 30 years with a diagnosis of AF were identified. Patients with ventricular tachycardia or with their only AF diagnosis within 30 days of cardiothoracic surgery were excluded. AAD use following the first AF encounter was determined from prescription claims for > 30 days supply of the AAD. Patients were then categorized into one of four mutually exclusive subgroups (heart failure, coronary artery disease, hypertension, or no heart disease) based upon their most serious concurrent heart disease diagnosis. AAD use within each subgroup was determined and compared to guideline recommendations.
Results: A total of 331,274 patients with AF were identified; of which 78,877 (24%) received > 1 AAD. The median age of those with an AAD was 57 years (IQR 52, 61) and 69% were male; in those without an AAD the median age was 56 (IQR 50,61) and 62% were male (p<0.001 for age and gender). The median number of days from first AF encounter to 1st AAD prescription claim was 29 days (IQR 9, 89). AAD use in guideline-based subgroups is presented in the Figure (bolded text indicate 1st line guideline recommendation). Despite being on the market for only 18 months of the 5 year study period, dronedarone accounted for 10% of all AAD use. Only 64% and 31% of AAD used in patients with HF and CAD, respectively, were 1st line guideline recommendations.
Conclusion: A large proportion of AAD use in patients with HF and CAD was not consistent with guideline recommendations and merits further investigation. Specifically the use of dronedarone in patients with HF and the use of Class Ic AAD in patients with CAD were of concern.
- © 2012 by American Heart Association, Inc.