title: Comparisons of hospitalization rates among younger atrial fibrillation patients receiving different antiarrhythmic drugs.
abstract: BACKGROUND
  Antiarrhythmic drugs (AADs) are used to reduce the frequency, severity, and duration of atrial fibrillation (AF) events, which should reduce hospitalizations; however, little is known about the associations between different AADs and hospitalization—particularly among younger AF patients without structural heart disease.
  
  
  RESULTS
  Using MarketScan® claims data, we identified AF patients without coronary artery disease or heart failure who received their first AAD prescription (amiodarone, sotalol, dronedarone, or Class Ic) within 14 days post-first AF encounter. The primary outcome was time from first AAD prescription to AF hospitalization, and secondary outcomes included time to cardiovascular and all-cause hospitalizations. We used inverse probability-weighted estimators to adjust for differences in treatment allocation in the Cox proportional hazards model for each outcome. Among 8562 AF patients with a median age of 56 years (interquartile range 49, 61), risk of AF hospitalization was greater with dronedarone than Class Ic (hazard ratio [HR] 1.59; 95% confidence interval 1.13-2.24), amiodarone (HR 2.63; 1.77-3.89), and sotalol (HR 1.72; 1.17-2.54), but lower with amiodarone versus Class Ic (HR 0.68; 0.57-0.80) and sotalol (HR 0.63; 0.53-0.75). Risk of cardiovascular hospitalization was lower with amiodarone than Class Ic (HR 0.80; 0.70-0.92), but not non-AF cardiovascular hospitalization (HR 1.26; 1.01-1.57). There was no difference in all-cause hospitalization between amiodarone, Class Ic, and sotalol.
  
  
  CONCLUSIONS
  Differences in hospitalization rates were found between AADs in younger AF patients without structural heart disease. Amiodarone had the lowest risk of AF hospitalization and dronedarone had the greatest risk. Additional research is needed to better understand associations between AADs and hospitalization risk.
authors.affiliation: From the Duke Clinical Research Institute (N.M. A. L., D.D., L.T., J. P.P., E.D.P., S.M.A-K.); Department of Medicine (N.M.A.L., J.P.P., E.D.P., S.M.A-K.), and Department of Biostatistics and Bioinformatics (L.T.), Duke University School of Medicine, Durham, NC. nancy.allenlapointe@dm.duke.edu.
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Allen LaPointe
authors.affiliation: From the Duke Clinical Research Institute (N.M. A. L., D.D., L.T., J. P.P., E.D.P., S.M.A-K.); Department of Medicine (N.M.A.L., J.P.P., E.D.P., S.M.A-K.), and Department of Biostatistics and Bioinformatics (L.T.), Duke University School of Medicine, Durham, NC.
authors.forename: David
authors.initials: D
authors.lastname: Dai
authors.affiliation: From the Duke Clinical Research Institute (N.M. A. L., D.D., L.T., J. P.P., E.D.P., S.M.A-K.); Department of Medicine (N.M.A.L., J.P.P., E.D.P., S.M.A-K.), and Department of Biostatistics and Bioinformatics (L.T.), Duke University School of Medicine, Durham, NC.
authors.forename: Laine
authors.initials: L
authors.lastname: Thomas
authors.affiliation: From the Duke Clinical Research Institute (N.M. A. L., D.D., L.T., J. P.P., E.D.P., S.M.A-K.); Department of Medicine (N.M.A.L., J.P.P., E.D.P., S.M.A-K.), and Department of Biostatistics and Bioinformatics (L.T.), Duke University School of Medicine, Durham, NC.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Piccini
authors.affiliation: From the Duke Clinical Research Institute (N.M. A. L., D.D., L.T., J. P.P., E.D.P., S.M.A-K.); Department of Medicine (N.M.A.L., J.P.P., E.D.P., S.M.A-K.), and Department of Biostatistics and Bioinformatics (L.T.), Duke University School of Medicine, Durham, NC.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: From the Duke Clinical Research Institute (N.M. A. L., D.D., L.T., J. P.P., E.D.P., S.M.A-K.); Department of Medicine (N.M.A.L., J.P.P., E.D.P., S.M.A-K.), and Department of Biostatistics and Bioinformatics (L.T.), Duke University School of Medicine, Durham, NC.
authors.forename: Sana M
authors.initials: SM
authors.lastname: Al-Khatib
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: antiarrhythmic drugs; atrial fibrillation; hospitalization
references.citation: JAMA. 2001 May 9;285(18):2370-5
references.pmid: 11343485
references.citation: Am J Cardiol. 2015 Feb 1;115(3):316-22
references.pmid: 25491240
references.citation: Circulation. 2003 Aug 12;108(6):711-6
references.pmid: 12885749
references.citation: Heart Rhythm. 2004 Nov;1(5):531-7
references.pmid: 15851214
references.citation: Med Care. 2005 Nov;43(11):1130-9
references.pmid: 16224307
references.citation: Circulation. 2006 Jul 11;114(2):119-25
references.pmid: 16818816
references.citation: N Engl J Med. 2008 Jun 19;358(25):2667-77
references.pmid: 18565859
references.citation: Am J Cardiol. 2008 Sep 1;102(5):568-72
references.pmid: 18721513
references.citation: N Engl J Med. 2009 Feb 12;360(7):668-78
references.pmid: 19213680
references.citation: Am J Cardiol. 2009 Dec 1;104(11):1534-9
references.pmid: 19932788
references.citation: Europace. 2011 May;13(5):626-33
references.pmid: 21296777
references.citation: Circ Cardiovasc Qual Outcomes. 2011 May;4(3):313-20
references.pmid: 21540439
references.citation: Europace. 2011 Aug;13(8):1118-26
references.pmid: 21576129
references.citation: Am J Cardiol. 2012 Feb 15;109(4):543-9
references.pmid: 22118826
references.citation: Circ Cardiovasc Qual Outcomes. 2012 Mar 1;5(2):171-81
references.pmid: 22373904
references.citation: Arch Intern Med. 2012 Jul 9;172(13):997-1004
references.pmid: 22664954
references.citation: Circulation. 2013 Jan 1;127(1):e6-e245
references.pmid: 23239837
references.citation: Int J Cardiol. 2013 Sep 10;167(6):2600-4
references.pmid: 22781508
references.citation: Am J Cardiol. 2013 Oct 15;112(8):1142-7
references.pmid: 23831166
references.citation: Am Heart J. 2013 Nov;166(5):871-8
references.pmid: 24176443
references.citation: Adv Ther. 2014 Mar;31(3):318-32
references.pmid: 24595638
references.citation: JAMA. 2014 Jun 4;311(21):2169-70
references.pmid: 24788549
references.citation: J Am Coll Cardiol. 2014 Jun 10;63(22):2376-84
references.pmid: 24727250
references.citation: J Am Coll Cardiol. 2014 Dec 2;64(21):e1-76
references.pmid: 24685669
references.citation: Circulation. 2001 Jul 17;104(3):292-6
references.pmid: 11457747