Outpatient prescribing of antiarrhythmic drugs from 1995 to 2000

Al‐Khatib, Sana M.; LaPointe, Nancy M. Allen; Curtis, Lesley H.; Kramer, Judith M.; Swann, Joslyn; Honig, Peter K.; Califf, Robert M.

doi:10.1016/s0002-9149(02)03008-4

Cited by 41 publications

(19 citation statements)

References 17 publications

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“…The Cardiac Arrhythmia Suppression Trial (CAST) results, published in 1991, showed increased mortality in patients surviving myocardial infarction (MI), 18 and caused sales of class IC antiarrhythmic drugs (AADs) to fall dramatically (by 75%) and there has been a considerable decrease since 1995 in the prescribing of class I AADs in favour of class III AADs. 19,20 However, the use of flecainide is supported by results from many randomized clinical trials, and the drug is recommended as a first-line treatment option for pharmacological cardioversion and maintenance of SR in the American College of Cardiology/American Heart Association/European Society of Cardiology (ACC/AHA/ESC) 2006 guidelines as well as in the 2010 update of the ESC's European guidelines. 3,4 This review aims to examine the 27 years of accumulated data on flecainide's safety and efficacy, and place the drug in its therapeutic context.…”

Section: Introductionmentioning

confidence: 99%

Twenty-five years in the making: flecainide is safe and effective for the management of atrial fibrillation

et al. 2010

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Atrial fibrillation (AF) is the most common arrhythmia in clinical practise and its prevalence is increasing. Over the last 25 years, flecainide has been used extensively worldwide, and its capacity to reduce AF symptoms and provide long-term restoration of sinus rhythm (SR) has been well documented. The increased mortality seen in patients treated with flecainide in the Cardiac Arrhythmia Suppression Trial (CAST) study, published in 1991, still deters many clinicians from using flecainide, denying many new AF patients a valuable treatment option. There is now a body of evidence that clearly demonstrates that flecainide has a favourable safety profile in AF patients without significant left ventricular disease or coronary heart disease. As a result of this evidence, flecainide is now recommended as one of the first-line treatment options for restoring and maintaining SR in patients with AF under current treatment guidelines. The objective of this article is to review the literature pertaining to the pharmacological characteristics, safety and efficacy of flecainide, and to place this drug in the context of current therapeutic management strategies for AF.

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Section: Introductionmentioning

confidence: 99%

Twenty-five years in the making: flecainide is safe and effective for the management of atrial fibrillation

et al. 2010

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“…This extensive use of amiodarone for AF management has been previously reported, but in a broader AF population that primarily included older patients and those with structural heart disease, where amiodarone has been and continues to be considered a first-line option. 11–16 …”

Section: Discussionmentioning

confidence: 99%

Antiarrhythmic Drug Use in Patients <65 Years With Atrial Fibrillation and Without Structural Heart Disease

LaPointe¹,

Dai²,

Thomas³

et al. 2015

The American Journal of Cardiology

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Little is known in clinical practice about antiarrhythmic drug (AAD) use in atrial fibrillation (AF) patients (particularly younger ones) that do not have structural heart disease. Using the MarketScan® database, we identified patients <65 years of age without known coronary artery disease or heart failure who had an AAD prescription claim (Class Ic drug, amiodarone, sotalol, or dronedarone) after their first AF encounter. A multinomial logistic regression model was created to assess factors associated with using each available AAD, compared with using Class Ic drugs before and after dronedarone was marketed in the United States. Additionally, we used the Kaplan Meier method to determine the rates of change in AAD use and discontinuation during the year post-AAD initiation. Of 8562 AF patients, 35% received Class Ic drugs, 34% amiodarone, 24% sotalol, and 7% dronedarone. The median patient age was 56 (IQR 49, 61) and 34% were female. Both before and after dronedarone was marketed, there was a statistically significant lower likelihood of Class Ic drug use versus other AAD use with increasing age, inpatient index AF encounter, and prior or concomitant anticoagulation therapy. During the 1 year post-AAD initiation, the AAD change rate was 14% for Class Ic drugs, 8% amiodarone, 17% sotalol, and 18% dronedarone (p<0.001); the AAD discontinuation rate was 40% for Class Ic drugs, 52% amiodarone, 40% sotalol, and 69% dronedarone (p<0.001). In conclusion, we found extensive use of amiodarone that may be inconsistent with guideline recommendations, and unexpectedly high rates of AAD discontinuation.

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“…1 According to a large evidencebased review, amiodarone has clinical value in patients with left ventricular dysfunction and heart failure as first-line treatment for atrial fibrillation and acute management of sustained ventricular tachyarrythmias. 2 It can have a prophylactic role during the perioperative period of cardiac surgery and may be an effective adjunct to implantable cardioverter-defibrillator therapy to reduce the number of shocks.…”

Section: Discussionmentioning

confidence: 99%

A 57 Year-old Man With Prolonged Shortness of Breath and Fevers

Chen¹

2008

TMF

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A 57 year-old Caucasian male was initially admitted to Methodist Hospital from an outside hospital for dehydration, increased heart rate, and weight loss. He has a past medical history of coronary artery disease status post myocardial infarction and coronary artery bypass graft, congestive heart failure, paroxysmal atrial fibrillation on coumadin, diabetes type II on insulin, and an orthotopic liver transplant in 1997 for end-stage liver disease secondary to hepatitis C virus and alpha-1 antitrypsin disorder.At the outside hospital, his one-month hospital course was complicated by acute on chronic renal failure which warranted hemodialysis, anemia that required transfusions, MRSA line sepsis from his Perm-A-Cath treated with vancomycin, and pneumonia, which was possibly secondary to aspiration. The patient was transferred to our facility for further management.Additional past medical history is significant for hyperlipidemia, depression and C3 to C5 fracture. Additional surgeries include AICD placement, a C3 to C4 diskectomy, cholecystectomy and appendectomy. Social history was negative for alcohol and substance abuse, but positive for a 30 pack year smoking history, which he quit one year ago. Family history was significant for diabetes, coronary artery disease and lung cancer. Current medications included amiodarone, aspirin, carvedilol, nexium, zetia, insulin, nebulizers, sirolimus, vancomycin, zosyn, and gentamicin. His only allergy was to meperidine.Initial vital signs were temperature 98.9˚ Fahrenheit, pulse 77 beats/minutes, respirations 16 breaths/minute, blood pressure 126/70 mm Hg, oxygen saturation 99 % on room air. The patient was in no acute distress. Physical exam was significant only for bilateral crackles at the lung bases, multiple skin tattoos, a rightsided Perm-A-Cath in the chest that was non-tender without surrounding erythema or swelling, and a surgical scar in the right upper quadrant.Chest radiograph on admission showed a right lower lobe consolidation, and he was continued on antibiotics for presumed pneumonia. The patient appeared to be improving after finishing his course of antibiotics for line sepsis and suspected pneumonia, and plans were made to transfer him to a subacute rehab with outpatient dialysis. One week after hospital transfer, he developed fevers and chills with accompanying shortness of breath. Blood cultures grew out pan-sensitive E. coli from his Perm-A-Cath. The catheter was removed and a Shiley catheter was placed. After completing a course of antibiotics, he remained afebrile, and when his blood cultures showed no growth for 48 hours, another Perm-A-Cath was placed. However, he became febrile again. A repeat chest radiograph showed increasing left lingular pneumonia in addition to an unchanged right lower lobe consolidation (Figure 1). At this point, he finished a course of empiric moxifloxacin which was recommended by the infectious disease service.He continued to have intermittent fevers, shortness of breath, a non-productive cough, and hypoxia that required oxyge...

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Outpatient prescribing of antiarrhythmic drugs from 1995 to 2000

Cited by 41 publications

References 17 publications

Twenty-five years in the making: flecainide is safe and effective for the management of atrial fibrillation

Twenty-five years in the making: flecainide is safe and effective for the management of atrial fibrillation

Antiarrhythmic Drug Use in Patients <65 Years With Atrial Fibrillation and Without Structural Heart Disease

A 57 Year-old Man With Prolonged Shortness of Breath and Fevers

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