Abstract 10216: Use of Antiarrhythmic Drug Therapy and Clinical Outcomes in Elderly Patients With Concomitant Atrial Fibrillation and Coronary Artery Disease
Background: Atrial fibrillation and CAD are common in older patients. We sought to describe the use of antiarrhythmic drug (AAD) therapy and clinical outcomes in older patients with atrial fibrillation (AF) and coronary artery disease (CAD).
Methods: We analyzed AAD therapy and outcomes in 1738 older patients (age ≥65) with AF and CAD in the Duke Databank for Cardiovascular Disease. The primary outcomes were adjusted hazards of mortality and rehospitalization at 1 and 5 years.
Results: Overall, 35% of patients were on an AAD at baseline, 43% were female and 85% were White. Prior MI (31%) and heart failure (41%) were common. Amiodarone was the most common AAD (21%), followed by pure class III agents (sotalol 6.3%, dofetilide 2.2%). Persistence of AAD therapy was low (21% at 1 year). Unadjusted mortality was highest in older patients (Figure), while rehospitalization rates were highest in patients on AAD. After adjustment, baseline use of AAD was not associated with mortality (adjusted HR 1.23, 95% CI 0.94-1.60) or cardiovascular mortality (adjusted HR 1.27, 95% CI 0.90-1.80) at 1 year. However, AAD use was associated with increased all-cause rehospitalization (adjusted HR 1.20, 95% CI 1.03-1.39) and cardiovascular rehospitalization (adjusted HR 1.20, 95% CI 1.01-1.43) at 1 year. This association did not persist at 5 years of follow-up.
Conclusions: Older patients with AF and CAD are at high risk of death and rehospitalization. Antiarrhythmic drug therapy was associated with increased risk of rehospitalization at 1 year. Alternative therapies for symptom control in this population are warranted.
- © 2013 by American Heart Association, Inc.