title: Mortality risk of long-term amiodarone therapy for atrial fibrillation patients without structural heart disease.
abstract: BACKGROUND
  Amiodarone is often prescribed in the management of atrial fibrillation (AF) but is known to cause significant end-organ toxicities. In this study, we examined the impact of amiodarone on all-cause mortality in AF patients with structurally normal hearts.
  
  
  METHODS
  We performed a retrospective cohort analysis of all AF patients with structurally normal hearts who were prescribed antiarrhythmic drugs (AAD) for rhythm control of AF at our institution from 2006 to 2013 (n = 2,077). Baseline differences between the amiodarone (AMIO: n = 403) and other AADs (NON-AMIO: n = 1,674) groups were corrected for using propensity score matching.
  
  
  RESULTS
  Amiodarone use as first-line therapy decreased significantly with a higher degree of prescriber specialization in arrhythmia management (31%, 22%, and 9% for primary care physicians, general cardiologists and cardiac electrophysiologists, respectively, p < 0.001). After propensity score matching, baseline comorbidities were balanced between the AMIO and NON-AMIO groups. Over a median follow-up of 28.2 months (range 6.0-100.9 months), amiodarone was associated with increased all-cause (HR 2.41, p = 0.012) and non-cardiac (HR 3.55, p = 0.008) mortality, but not cardiac mortality. AF recurrence and cardiac hospitalizations were similar between the two study groups.
  
  
  CONCLUSIONS
  Amiodarone treatment of AF is associated with increased mortality in patients without structural heart disease and therefore should be avoided or only used as a second-line therapy, when other AF therapies fail. Adherence to guideline recommendations in the management of AF patients impacts clinical outcome.
authors.forename: Dingxin
authors.initials: D
authors.lastname: Qin
authors.forename: George
authors.initials: G
authors.lastname: Leef
authors.forename: Mian Bilal
authors.initials: MB
authors.lastname: Alam
authors.forename: Rohit
authors.initials: R
authors.lastname: Rattan
authors.forename: Mohamad Bilal
authors.initials: MB
authors.lastname: Munir
authors.forename: Divyang
authors.initials: D
authors.lastname: Patel
authors.forename: Furqan
authors.initials: F
authors.lastname: Khattak
authors.forename: Evan
authors.initials: E
authors.lastname: Adelstein
authors.forename: Sandeep K
authors.initials: SK
authors.lastname: Jain
authors.affiliation: University of Pittsburgh Medical Center. sabas@upmc.edu.
authors.forename: Samir
authors.initials: S
authors.lastname: Saba
mesh_terms: D000368:Aged; D000638:Amiodarone / Q000008:administration & dosage*; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases; D006801:Humans; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D000638:Amiodarone
keywords: amiodarone; atrial fibrillation; mortality; outcome