Comparative effectiveness of antiarrhythmic drugs on cardiovascular hospitalization and mortality in atrial fibrillation.
OBJECTIVE
To assess, through a systematic review, evidence for the effects of antiarrhythmic drugs (AADs) on cardiovascular (CV) hospitalization and mortality.


METHODS
English language articles were identified using MEDLINE, EMBASE and the Cochrane Clinical Trial Registry and were screened for study applicability and methodological quality.


RESULTS
Out of 3526 identified studies, 38 were selected for analysis (19 evaluated individual AADs, 13 compared rate- versus rhythm-control strategies, and 6 evaluated multiple AADs but did not report outcomes for individual agents). None of the studies examining individual AADs employed the CV hospitalization end point used in ATHENA (the reference trial). There were no head-to-head comparisons of individual AADs on CV hospitalization. Most high-quality studies used multidrug rate- versus rhythm-control strategies.


CONCLUSIONS
Assessment of the comparative effectiveness of individual AADs on CV hospitalization and mortality end points is not possible with the current evidence.
Leonard D Schaeffer Center for Health Policy & Economics, University of Southern California, 650 Childs Way, Los Angeles, CA 90089-90626, USA. dlakdawa@healthpolicy.usc.edu.
Darius
D
Lakdawalla
Mintu P
MP
Turakhia
Mehul
M
Jhaveri
Essy
E
Mozaffari
Pamela
P
Davis
Lily
L
Bradley
Matthew D
MD
Solomon
D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000401:mortality; D002318:Cardiovascular Diseases / Q000401:mortality / Q000628:therapy; D057186:Comparative Effectiveness Research; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents