Arrhythmias & electrophysiology
Cardiovascular outcomes in patients with atrial fibrillation concomitantly treated with antiarrhythmic drugs and non-vitamin k antagonist oral anticoagulants
Authors' conclusion
The use of dronedarone with NOACs was associated with cardiovascular benefits in an Asian population, compared with non-dronedarone AADs and amiodarone.
Study context
- Population
- AF patients taking AADs with concomitant NOACs, 2012–17; excluded bradycardia, heart block, HF admission, mitral stenosis, prosthetic valve, follow-up <3 monthsDronedarone n 2298 / 2231 / 812 by protocol
- Exposure
- Dronedarone vs other AADs with concomitant NOACs
- Non-dronedaronen = 6,984reference
- Amiodaronen = 6,693reference
- Propafenonen = 2,436reference
- Outcome
- Protocol 1: dronedarone vs non-dronedarone
Methodological detailsnational health insurance database
- National health insurance database
Main finding
As reported in the abstract
Dronedarone vs Non-dronedaroneHazard ratio (95% CI)P value
CV death
0.24(0.16–0.37)
P < 0.0001All-cause mortality
0.33(0.27–0.42)
P < 0.0001MACE
0.56(0.45–0.70)
P < 0.0001Observational data: associations, not effects.
Secondary outcomes
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Protocol 2: dronedarone vs amiodaroneDronedaronevs AmiodaroneCV death | 0.20 (0.13–0.31) | P < 0.0001 | |
| Protocol 2: dronedarone vs amiodaroneDronedaronevs AmiodaroneAll-cause mortality | 0.27 (0.22–0.34) | P < 0.0001 | |
| Protocol 2: dronedarone vs amiodaroneDronedaronevs AmiodaroneMACE | 0.53 (0.43–0.66) | P < 0.0001 | |
| 0.10.31310Hazard ratio (log scale) |
- Protocol 2: dronedarone vs amiodarone: 2231 dronedarone vs 6693 amiodarone users analysed
Protocol 3: dronedarone vs propafenone
- No differences between the two drugs for primary and secondary outcomes
- 812 dronedarone vs 2436 propafenone users analysed
Safety
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| ICHDronedaronevs Non-dronedaroneProtocol 1 | 0.61 (0.38–0.99) | P = 0.0436 | |
| ICHDronedaronevs AmiodaroneProtocol 2 | 0.53 (0.33–0.84) | P = 0.0078 | |
| 0.20.5125Hazard ratio (log scale) |
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Cardiovascular outcomes in patients with atrial fibrillation concomitantly treated with antiarrhythmic drugs and non-vitamin k antagonist oral anticoagulants. Europace. Published 31 March 2023. doi:10.
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