title: Trends in the pharmacologic management of atrial fibrillation: Data from the Veterans Affairs health system.
abstract: BACKGROUND
  Prescribing rate control medications with or without antiarrhythmic drugs is often the first course treatment for atrial fibrillation (AF). Clinical trial data suggest that antiarrhythmic drugs are only marginally effective and have multiple drawbacks, whereas rate control alone is sufficient for most patients with minimally symptomatic AF. This study investigates changes in the use of oral rate and rhythm control therapy for AF during fiscal years 2002 through 2011 in the US Veterans Affairs (VA) health system.
  
  
  METHODS
  Patients with new AF episodes were identified in Veterans Health Administration administrative data files, and receipt of oral rate- and rhythm-controlling drugs within 90 days of new AF episodes was determined for each patient.
  
  
  RESULTS
  The percentage of patients receiving an oral rate-controlling medication decreased from 74.9% in 2002 through 2003 to 70.9% in 2010 through 2011. The use of digoxin decreased by >50%, whereas the use of β-blockers metoprolol and carvedilol increased. The proportion of patients receiving any oral antiarrhythmic medication decreased from 13.5% in 2002 through 2003 to 11.6% in 2010 through 2011, and use of the most frequently prescribed oral antiarrhythmic, amiodarone, decreased by 17%.
  
  
  CONCLUSIONS
  Rate control remains the dominant strategy for treating new AF. The decrease in the use of oral antiarrhythmics may be due to lack of concrete data suggesting mortality and morbidity benefit as well as increasing use of the ablation approach.
  The proportion of patients with new AF episodes who were prescribed oral rate or rhythm control medications decreased modestly from 2002 through 2011. The use of digoxin decreased by >50%, and amiodarone decreased by 17%. Rate control remains the dominant strategy for treating new AF.
authors: Comprehensive Access and Delivery Research and Evaluation Center, Iowa City Veterans Affairs Medical Center, Iowa, IA; General Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa, IA. Electronic address: mary-vaughan-sarrazin@uiowa.edu.
authors: Mary S
authors: MS
authors: Vaughan-Sarrazin
authors: Cardiovascular Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa, IA.
authors: Alexander
authors: A
authors: Mazur
authors: Department of Epidemiology, College of Public Health, University of Iowa, Iowa, IA.
authors: Elizabeth
authors: E
authors: Chrischilles
authors: Comprehensive Access and Delivery Research and Evaluation Center, Iowa City Veterans Affairs Medical Center, Iowa, IA; General Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa, IA.
authors: Peter
authors: P
authors: Cram
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D008297:Male; D009017:Morbidity / Q000639:trends; D011379:Prognosis; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*
chemical_list: D000889:Anti-Arrhythmia Agents