Arrhythmias & electrophysiologyCohort study
Amiodarone and pulmonary toxicity in atrial fibrillation: a nationwide Israeli study
- Retrospective cohort study
- nationwide population-based
- matched 1:1
- Inverse probability treatment weighting (IPTW)
Authors' conclusion
In a contemporary AF population, low-dose amiodarone was associated with a trend towards increased risk of ILD (15%-45%) but a clinically negligible change in absolute risk (maximum of 1.8%), no increased risk of PLC, and a lower risk of all-cause mortality.
Study context
- Population
- Patients with incident atrial fibrillation (AF), without prior interstitial lung disease (ILD) or primary lung cancer, Israel, 1999–2021matched pairs
- Exposure
- Amiodarone vs no amiodarone
- Amiodaronen = 6,039
- Outcome
- Incidence of any interstitial lung disease (ILD)
Main finding
Any ILD · mean follow-up 4.2 years
Hazard ratio
1.45
95% CI 0.97–2.44
P = 0.09
Amiodarone vs Controls
HR 1.45 (95% CI 0.97–2.44); P = 0.09
As reported in the abstract
- ILD occurred overall
- 242 (2.0%)
- Trivial higher relative risk of ILD with amiodarone between Years 2 and 8 (maximal RR)
- 1.019
Observational data: associations, not effects.
Secondary outcomes
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| All-cause death · after IPTW | 0.65 (0.60–0.72) | P < 0.001 | |
| Primary lung cancer · after IPTW | 1.18 (0.76–2.08) | P = 0.53 | |
| 0.512Hazard ratio (log scale) |
- All-cause death — Death occurred overall
- 2185 (18.1%)
- Primary lung cancer — primary lung cancer (PLC) occurred overall
- 97 (0.8%)
Sensitivity analyses
- Results consistent across a variety of sensitivity analyses
Original publication
Amiodarone and pulmonary toxicity in atrial fibrillation: a nationwide Israeli study. Eur Heart J. Published 6 November 2023. doi:10.1093/eurheartj/ehad726
Summarised from the published abstract; every number is checked against it