title: Use of antiarrhythmic drug therapy and clinical outcomes in older patients with concomitant atrial fibrillation and coronary artery disease.
abstract: OBJECTIVE
  Atrial fibrillation (AF) and coronary artery disease (CAD) are common in older patients. We aimed to describe the use of antiarrhythmic drug (AAD) therapy and clinical outcomes in these patients.
  
  
  RESULTS
  We analysed 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 mortality and rehospitalization at 1 and 5 years. Overall, 35% of patients received an AAD at baseline, 43% were female and 85% were white. Prior myocardial infarction (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 was low (35% at 1 year). After adjustment, baseline AAD use was not associated with 1-year mortality [adjusted hazard ratio (HR) 1.23, 95% confidence interval (CI) 0.94-1.60] or cardiovascular mortality (adjusted HR 1.27, 95% CI 0.90-1.80). 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; however, these patients were at very high risk of death (55% for those >75 and on AAD) and all-cause rehospitalization (87% for those >75 and on AAD) at 5 years.
  
  
  CONCLUSIONS
  In older patients with AF and CAD, antiarrhythmic therapy was associated with increased rehospitalization at 1 year. Overall, these patients are at high risk of longer-term hospitalization and death. Safer, better-tolerated, and more effective therapies for symptom control in this high-risk population are warranted.
authors.affiliation: Duke Center for Atrial Fibrillation, Durham, NC, USA Department of Medicine, Duke University Medical Center, Durham, NC, USA Duke Clinical Research Institute, Duke University Medical Center, PO Box 17969, Durham, NC 27715, USA benjamin.steinberg@duke.edu.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Steinberg
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, PO Box 17969, Durham, NC 27715, USA.
authors.forename: Samuel H
authors.initials: SH
authors.lastname: Broderick
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, USA Duke Clinical Research Institute, Duke University Medical Center, PO Box 17969, Durham, NC 27715, USA.
authors.forename: Renato D
authors.initials: RD
authors.lastname: Lopes
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, PO Box 17969, Durham, NC 27715, USA.
authors.forename: Linda K
authors.initials: LK
authors.lastname: Shaw
authors.affiliation: Duke Center for Atrial Fibrillation, Durham, NC, USA Department of Medicine, Duke University Medical Center, Durham, NC, USA Duke Clinical Research Institute, Duke University Medical Center, PO Box 17969, Durham, NC 27715, USA.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Thomas
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: Tracy A
authors.initials: TA
authors.lastname: DeWald
authors.affiliation: Duke Center for Atrial Fibrillation, Durham, NC, USA Department of Medicine, Duke University Medical Center, Durham, NC, USA Duke Clinical Research Institute, Duke University Medical Center, PO Box 17969, Durham, NC 27715, USA.
authors.forename: James P
authors.initials: JP
authors.lastname: Daubert
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, USA Duke Clinical Research Institute, Duke University Medical Center, PO Box 17969, Durham, NC 27715, USA.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, USA Duke Clinical Research Institute, Duke University Medical Center, PO Box 17969, Durham, NC 27715, USA.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
authors.affiliation: Duke Center for Atrial Fibrillation, Durham, NC, USA Department of Medicine, Duke University Medical Center, Durham, NC, USA Duke Clinical Research Institute, Duke University Medical Center, PO Box 17969, Durham, NC 27715, USA.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Piccini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000401:mortality*; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Antiarrhythmic drug; Atrial fibrillation; Elderly; Ischaemic heart disease; Outcomes research
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