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Analysis of cause-specific mortality in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study.

https://arctichealth.org/en/permalink/ahliterature17828
Source
Circulation. 2004 Apr 27;109(16):1973-80
Publication Type
Article
Date
Apr-27-2004
Author
Jonathan S Steinberg
Ara Sadaniantz
Jack Kron
Andrew Krahn
D Marty Denny
James Daubert
W Barton Campbell
Edward Havranek
Katherine Murray
Brian Olshansky
Gearoid O'Neill
Magdi Sami
Stanley Schmidt
Randle Storm
Miguel Zabalgoitia
John Miller
Mary Chandler
Elaine M Nasco
H Leon Greene
Author Affiliation
Division of Cardiology, St Luke's-Roosevelt Hospital Center and Columbia University, New York, NY 10025, USA. jss7@columbia.edu
Source
Circulation. 2004 Apr 27;109(16):1973-80
Date
Apr-27-2004
Language
English
Publication Type
Article
Keywords
Aged
Anti-Arrhythmia Agents - therapeutic use
Atrial Fibrillation - drug therapy - mortality
Follow-Up Studies
Humans
Proportional Hazards Models
Research Support, U.S. Gov't, P.H.S.
Survival Analysis
Abstract
BACKGROUND: Expectations that reestablishing and maintaining sinus rhythm in patients with atrial fibrillation might improve survival were disproved in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. This report describes the cause-specific modes of death in the AFFIRM treatment groups. METHODS AND RESULTS: All deaths in patients enrolled in AFFIRM underwent blinded review by the AFFIRM Events Committee, and a mode of death was assigned. In AFFIRM, 2033 patients were randomized to a rhythm-control strategy and 2027 patients to a rate-control strategy. During a mean follow-up of 3.5 years, there were 356 deaths in the rhythm-control patients and 310 deaths in the rate-control patients (P=0.07). In the rhythm-control group, 129 patients (9%) died of a cardiac cause, and in the rate-control group, 130 patients (10%) died (P=0.95). Both groups had similar rates of arrhythmic and nonarrhythmic cardiac deaths. The numbers of vascular deaths were similar in the 2 groups: 35 (3%) in the rhythm-control group and 37 (3%) in the rate-control group (P=0.82). There were no differences in the rates of ischemic stroke and central nervous system hemorrhage. In the rhythm-control group, there were 169 noncardiovascular deaths (47.5% of the total number of deaths), whereas in the rate-control arm, there were 113 noncardiovascular deaths (36.5% of the total number of deaths) (P=0.0008). Differences in noncardiovascular death rates were due to pulmonary and cancer-related deaths. CONCLUSIONS: Management of atrial fibrillation with a rhythm-control strategy conferred no advantage over a rate-control strategy in cardiac or vascular mortality and may be associated with an increased noncardiovascular death rate.
Notes
Comment In: Circulation. 2004 Sep 14;110(11):e307-8; author reply e307-815364827
PubMed ID
15051639 View in PubMed
Less detail

Antiarrhythmic therapy and risk of death in patients with atrial fibrillation: a nationwide study.

https://arctichealth.org/en/permalink/ahliterature150959
Source
Europace. 2009 Jul;11(7):886-91
Publication Type
Article
Date
Jul-2009
Author
Søren Skøtt Andersen
Morten Lock Hansen
Gunnar H Gislason
Tina Ken Schramm
Fredrik Folke
Emil Fosbøl
Steen Z Abildstrøm
Mette Madsen
Lars Køber
Christian Torp-Pedersen
Author Affiliation
Department of Cardiology, Gentofte University Hospital, Niels Andersens Vej 65, Hellerup, Copenhagen DK-2900, Denmark. ssa@heart.dk
Source
Europace. 2009 Jul;11(7):886-91
Date
Jul-2009
Language
English
Publication Type
Article
Keywords
Aged
Anti-Arrhythmia Agents - therapeutic use
Atrial Fibrillation - drug therapy - mortality
Cohort Studies
Denmark - epidemiology
Female
Humans
Incidence
Male
Middle Aged
Proportional Hazards Models
Registries
Risk assessment
Risk factors
Survival Analysis
Survival Rate
Treatment Outcome
Abstract
To examine the risk of death associated with antiarrhythmic drug (AAD) therapy in a nationwide unselected cohort of patients with atrial fibrillation (AF).
All patients admitted with AF in Denmark from 1995 to 2004 and their subsequent use of AADs were identified by individual-level linkage of nationwide registries. Multivariable Cox proportional-hazard models with time-dependent covariates were used to analyse the risk of death associated with AAD therapy. A total of 141,500 patients were included in the study; of these 3356 (2.4%) patients received treatment with flecainide, 3745 (2.6%) propafenone, 23,346 (16.5%) sotalol, and 10,376 (7.3%) amiodarone. Annualized mortality rates were 2.54, 4.25, 5.29, and 7.42 per year per 100 person years for flecainide, propafenone, sotalol, and amiodarone, respectively. Multivariable Cox proportional-hazard models did not show increased risk of death associated with any of the AADs. Hazard ratio (95% confidence interval) for flecainide 0.38 (0.32-0.44), propafenone 0.65 (0.58-0.71), sotalol 0.65 (0.63-0.67), and amiodarone 0.94 (0.89-1.00).
In an unselected cohort of patients with AF, antiarrhythmic treatment with flecainide, propafenone, sotalol, or amiodarone was not associated with increased risk of death. From a safety perspective, this indicates appropriate selection of patients for AAD therapy.
Notes
Comment In: Europace. 2009 Jul;11(7):840-119546183
Comment In: Europace. 2009 Jul;11(7):837-919546182
PubMed ID
19443433 View in PubMed
Less detail
Source
Eur Heart J. 1999 Nov;20(21):1525-7
Publication Type
Article
Date
Nov-1999
Author
G Y Lip
Source
Eur Heart J. 1999 Nov;20(21):1525-7
Date
Nov-1999
Language
English
Publication Type
Article
Keywords
Anti-Arrhythmia Agents - therapeutic use
Atrial Fibrillation - drug therapy - mortality
Comorbidity
Denmark - epidemiology
Heart Failure, Congestive - epidemiology
Humans
Prognosis
Risk assessment
Notes
Comment On: Eur Heart J. 1999 Nov;20(21):1592-910529328
PubMed ID
10529317 View in PubMed
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Bleeding after initiation of multiple antithrombotic drugs, including triple therapy, in atrial fibrillation patients following myocardial infarction and coronary intervention: a nationwide cohort study.

https://arctichealth.org/en/permalink/ahliterature121881
Source
Circulation. 2012 Sep 4;126(10):1185-93
Publication Type
Article
Date
Sep-4-2012
Author
Morten Lamberts
Jonas Bjerring Olesen
Martin Huth Ruwald
Carolina Malta Hansen
Deniz Karasoy
Søren Lund Kristensen
Lars Køber
Christian Torp-Pedersen
Gunnar Hilmar Gislason
Morten Lock Hansen
Author Affiliation
Department of Cardiology, Post 635, Copenhagen University Hospital Gentofte, Niels Andersens Vej 65, 2900 Hellerup, Denmark. mortenlamberts@gmail.com
Source
Circulation. 2012 Sep 4;126(10):1185-93
Date
Sep-4-2012
Language
English
Publication Type
Article
Keywords
Acute Coronary Syndrome - drug therapy - mortality
Aged
Aged, 80 and over
Angioplasty, Balloon, Coronary
Aspirin - administration & dosage - adverse effects
Atrial Fibrillation - drug therapy - mortality
Cohort Studies
Comorbidity
Denmark - epidemiology
Drug Therapy, Combination - adverse effects
Female
Fibrinolytic Agents - administration & dosage - adverse effects
Hemorrhage - chemically induced - mortality - prevention & control
Humans
Male
Middle Aged
Myocardial Infarction - mortality - therapy
Platelet Aggregation Inhibitors - administration & dosage - adverse effects
Registries - statistics & numerical data
Risk factors
Stroke - mortality
Ticlopidine - administration & dosage - adverse effects - analogs & derivatives
Vitamin K - antagonists & inhibitors
Abstract
Uncertainty remains over optimal antithrombotic treatment of patients with atrial fibrillation presenting with myocardial infarction and/or undergoing percutaneous coronary intervention. We investigated the risk and time frame for bleeding following myocardial infarction/percutaneous coronary intervention in patients with atrial fibrillation according to antithrombotic treatment.
Patients with atrial fibrillation and admitted with myocardial infarction or for percutaneous coronary intervention between 2000 and 2009 (11 480 subjects, mean age 75.6 years [SD ±10.3], males 60.9%) were identified by individual level linkage of nationwide registries in Denmark. Fatal or nonfatal (requiring hospitalization) bleeding was determined according to antithrombotic treatment regimen: triple therapy (TT) with vitamin K antagonist (VKA)+aspirin+clopidogrel, VKA+antiplatelet, and dual antiplatelet therapy with aspirin+clopidogrel. We calculated crude incidence rates and adjusted hazard ratios by Cox regression models. Within 1 year, 728 bleeding events were recorded (6.3%); 79 were fatal (0.7%). Within 30 days, rates were 22.6, 20.3, and 14.3 bleeding events per 100 person-years for TT, VKA+antiplatelet, and dual antiplatelet therapy, respectively. Both early (within 90 days) and delayed (90-360 days) bleeding risk with TT exposure in relation to VKA+antiplatelet was increased; hazard ratio 1.47 (1.04;2.08) and 1.36 (0.95;1.95), respectively. No significant difference in thromboembolic risk was observed for TT versus VKA+antiplatelet; hazard ratio, 1.15 (0.95;1.40).
High risk of bleeding is immediately evident with TT after myocardial infarction/percutaneous coronary intervention in patients with atrial fibrillation. A continually elevated risk associated with TT indicates no safe therapeutic window, and TT should only be prescribed after thorough bleeding risk assessment of patients.
Notes
Comment In: Circulation. 2013 Apr 30;127(17):e58523762910
Comment In: Circulation. 2012 Sep 4;126(10):1176-822869840
Comment In: Circulation. 2013 Apr 30;127(17):e58423630091
PubMed ID
22869839 View in PubMed
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Comparative effectiveness of rhythm control vs rate control drug treatment effect on mortality in patients with atrial fibrillation.

https://arctichealth.org/en/permalink/ahliterature123786
Source
Arch Intern Med. 2012 Jul 9;172(13):997-1004
Publication Type
Article
Date
Jul-9-2012
Author
Raluca Ionescu-Ittu
Michal Abrahamowicz
Cynthia A Jackevicius
Vidal Essebag
Mark J Eisenberg
Willy Wynant
Hugues Richard
Louise Pilote
Author Affiliation
Harvard School of Public Health, Harvard University, Boston, Massachusetts, USA.
Source
Arch Intern Med. 2012 Jul 9;172(13):997-1004
Date
Jul-9-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Anti-Arrhythmia Agents - administration & dosage - pharmacology - therapeutic use
Atrial Fibrillation - drug therapy - mortality - physiopathology
Comparative Effectiveness Research
Databases, Factual
Female
Heart Conduction System - drug effects - physiopathology
Heart Rate - drug effects
Humans
Male
Odds Ratio
Proportional Hazards Models
Quebec - epidemiology
Retrospective Studies
Survival Analysis
Treatment Outcome
Abstract
Controversy continues concerning the choice of rhythm control vs rate control treatment strategies for atrial fibrillation (AF). A recent clinical trial showed no difference in 5-year mortality between the 2 treatments. We aimed to determine whether the 2 strategies have similar effectiveness when applied to a general population of patients with AF with longer follow-up.
We used population-based administrative databases from Quebec, Canada, from 1999 to 2007 to select patients 66 years or older hospitalized with an AF diagnosis who did not have AF-related drug prescriptions in the year before the admission but received a prescription within 7 days of discharge. Patients were followed until death or administrative censoring. Mortality was analyzed by multivariable Cox regression.
Among 26,130 patients followed for a mean (SD) period of 3.1 years (2.3 years), there were 13,237 deaths (49.5%). After adjusting for covariates, we found that the effect of rhythm vs rate control drugs changed over time: after a small increase in mortality for patients treated with rhythm control in the 6 months following treatment initiation (hazard ratio [HR], 1.07; 95% CI, 1.01-1.14), the mortality was similar between the 2 groups until year 4 but decreased steadily in the rhythm control group after year 5 (HR, 0.89; 95% CI, 0.81-0.96; and HR, 0.77; 95% CI, 0.62-0.95, after 5 and 8 years, respectively).
In this population-based sample of patients with AF, we found little difference in mortality within 4 years of treatment initiation between patients with AF initiating rhythm control therapy vs those initiating rate control therapy. However, rhythm control therapy seems to be superior in the long-term.
Notes
Comment In: Arch Intern Med. 2012 Jul 9;172(13):983-422665022
Erratum In: Arch Intern Med. 2012 Jul 23;172(14):1085
PubMed ID
22664954 View in PubMed
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Comparison of management patterns and clinical outcomes in patients with atrial fibrillation in Canada and the United States (from the analysis of the Atrial Fibrillation Follow-up Investigation of Rhythm Management [AFFIRM] database).

https://arctichealth.org/en/permalink/ahliterature53088
Source
Am J Cardiol. 2005 Sep 15;96(6):815-21
Publication Type
Article
Date
Sep-15-2005
Author
Gilles E O'Hara
Lyne Charbonneau
Mary Chandler
Humberto J Vidaillet
François Philippon
Magdi Sami
Thomas A Rocco
Farooq A Padder
Jean Champagne
Craig M Pratt
Benoit Coutu
D George Wyse
Author Affiliation
Institut de Cardiologie, Hôpital Laval, Quebec, Quebec, Canada. gilles.ohara@med.ulaval.ca
Source
Am J Cardiol. 2005 Sep 15;96(6):815-21
Date
Sep-15-2005
Language
English
Publication Type
Article
Keywords
Aged
Anti-Arrhythmia Agents - therapeutic use
Anticoagulants - therapeutic use
Atrial Fibrillation - drug therapy - mortality
Canada - epidemiology
Comparative Study
Female
Follow-Up Studies
Heart Rate - drug effects
Humans
Male
Middle Aged
Physician's Practice Patterns
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.
Treatment Outcome
United States - epidemiology
Warfarin - therapeutic use
Abstract
Little is known about differences in practice patterns or outcomes in the management of patients who have atrial fibrillation in Canada compared with those in the United States (US). We evaluated the effect that the country of enrollment may have on the management patterns and clinical outcomes in patients who participated in the AFFIRM study. Three thousand four hundred patients came from the US and 660 from Canada. In the US, patients were more likely to have a history of coronary artery disease (39% vs 35%, p = 0.03), hypertension (72% vs 67%, p = 0.01), or congestive heart failure (24% vs 18%, p = 0.0002). More US participants were
PubMed ID
16169368 View in PubMed
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Comparison of nested case-control and survival analysis methodologies for analysis of time-dependent exposure.

https://arctichealth.org/en/permalink/ahliterature176474
Source
BMC Med Res Methodol. 2005 Jan 25;5(1):5
Publication Type
Article
Date
Jan-25-2005
Author
Vidal Essebag
Robert W Platt
Michal Abrahamowicz
Louise Pilote
Author Affiliation
Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA. vessebag@bidmc.harvard.edu
Source
BMC Med Res Methodol. 2005 Jan 25;5(1):5
Date
Jan-25-2005
Language
English
Publication Type
Article
Keywords
Aged
Amiodarone - therapeutic use
Anti-Arrhythmia Agents - therapeutic use
Atrial Fibrillation - drug therapy - mortality - surgery
Case-Control Studies
Cohort Studies
Female
Humans
Male
Pacemaker, Artificial
Proportional Hazards Models
Quebec
Risk factors
Survival Analysis
Time Factors
Abstract
Epidemiological studies of exposures that vary with time require an additional level of methodological complexity to account for the time-dependence of exposure. This study compares a nested case-control approach for the study of time-dependent exposure with cohort analysis using Cox regression including time-dependent covariates.
A cohort of 1340 subjects with four fixed and seven time-dependent covariates was used for this study. Nested case-control analyses were repeated 100 times for each of 4, 8, 16, 32, and 64 controls per case, and point estimates were compared to those obtained using Cox regression on the full cohort. Computational efficiencies were evaluated by comparing central processing unit times required for analysis of the cohort at sizes 1, 2, 4, 8, 16, and 32 times its initial size.
Nested case-control analyses yielded results that were similar to results of Cox regression on the full cohort. Cox regression was found to be 125 times slower than the nested case-control approach (using four controls per case).
The nested case-control approach is a useful alternative for cohort analysis when studying time-dependent exposures. Its superior computational efficiency may be particularly useful when studying rare outcomes in databases, where the ability to analyze larger sample sizes can improve the power of the study.
Notes
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PubMed ID
15670334 View in PubMed
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Dronedarone for atrial fibrillation: the limited reliability of clinical practice guidelines.

https://arctichealth.org/en/permalink/ahliterature104965
Source
JAMA Intern Med. 2014 Apr;174(4):625-9
Publication Type
Article
Date
Apr-2014
Author
Primiano Iannone
Enrico Haupt
Gaddo Flego
Paola Truglio
Monica Minardi
Simon Clarke
Nicola Magrini
Author Affiliation
Emergency Department, Tigullio Hospital, Lavagna, Italy.
Source
JAMA Intern Med. 2014 Apr;174(4):625-9
Date
Apr-2014
Language
English
Publication Type
Article
Keywords
Amiodarone - analogs & derivatives - therapeutic use
Anti-Arrhythmia Agents - therapeutic use
Atrial Fibrillation - drug therapy - mortality
Canada
Evidence-Based Medicine
Heart Rate - drug effects
Humans
Practice Guidelines as Topic
Recurrence
Reproducibility of Results
United States
Abstract
Concerns have been expressed about the reliability of clinical practice guidelines. We analyzed 3 guidelines from medical specialty societies about dronedarone hydrochloride, an antiarrhythmic drug related to amiodarone hydrochloride, for treatment of patients with atrial fibrillation. We compared the recommendations in these guidelines with the conclusions about dronedarone that we reached by applying the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Method to the same evidence base. In our analysis, as a rate control drug, dronedarone was better than placebo only for a surrogate outcome (heart rate). As a rhythm control drug, dronedarone was associated with 13 (95% CI, -15 to 61) excess deaths per 1000 patients treated as compared with placebo. Compared with amiodarone, dronedarone was less effective (214 [95% CI, 130 to 294] more recurrences of atrial fibrillation per 1000 patients treated) and similarly tolerated (-28 [95% CI, -69 to 33] more serious adverse events requiring drug suspension per 1000 patients treated). Despite the limits of the evidence, all 3 guidelines recommended dronedarone for prevention of recurrences of atrial fibrillation; 2 of the guidelines recommended it as a rate control agent. Our findings raise questions about the reliability of these clinical practice guidelines, as well as the financial associations between many of the panel members and the manufacturer of dronedarone.
PubMed ID
24535046 View in PubMed
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Effect of cardiovascular drug classes on all-cause mortality among atrial fibrillation patients treated in primary care in Sweden: a cohort study.

https://arctichealth.org/en/permalink/ahliterature120578
Source
Eur J Clin Pharmacol. 2013 Feb;69(2):279-87
Publication Type
Article
Date
Feb-2013
Author
Per Wändell
Axel C Carlsson
Kristina Sundquist
Sven-Erik Johansson
Jan Sundquist
Author Affiliation
Centre for Family Medicine, Karolinska Institutet, Alfred Nobels Allé 12, 141 83 Huddinge, Sweden. per.wandell@ki.se
Source
Eur J Clin Pharmacol. 2013 Feb;69(2):279-87
Date
Feb-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Atrial Fibrillation - drug therapy - mortality
Cardiovascular Agents - therapeutic use
Cohort Studies
Female
Hematologic Agents - therapeutic use
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Male
Middle Aged
Primary Health Care - statistics & numerical data
Sweden - epidemiology
Abstract
Risk factors for stroke are well known in atrial fibrillation (AF) patients, while less is known on the effect of these factors on total mortality.
Our aim was to study the impact of cardiovascular drug classes on mortality in AF patients treated in primary care.
The study population was chosen based on patient data from 75 primary care centres in Sweden compiled in a database. Individuals diagnosed with AF who were older than 45 years were enrolled (n?=?12,302, of whom 6,660 were men). Cox regression analysis with mortality (years to death) as outcome was conducted in the men and women separately, as well in the age categories
PubMed ID
22990327 View in PubMed
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Effect of cardiovascular drugs on mortality in atrial fibrillation and chronic heart failure.

https://arctichealth.org/en/permalink/ahliterature267094
Source
Scand Cardiovasc J. 2014 Oct;48(5):291-8
Publication Type
Article
Date
Oct-2014
Author
Per Wändell
Axel C Carlsson
Jan Sundquist
Sven-Erik Johansson
Matteo Bottai
Kristina Sundquist
Source
Scand Cardiovasc J. 2014 Oct;48(5):291-8
Date
Oct-2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Atrial Fibrillation - drug therapy - mortality
Comorbidity
Heart Failure - drug therapy - mortality
Humans
Middle Aged
Retrospective Studies
Sweden - epidemiology
Abstract
To study mortality rates among men and women with atrial fibrillation (AF) and concomitant chronic heart failure (CHF) prescribed different classes of cardiovascular drugs in primary health care.
A cohort of men (n = 1159) and women (n = 1155) aged 45 years or above and diagnosed with both AF and CHF from patient records from 75 primary care centers in Sweden were included in the study. Regression models with mortality as the outcome were used, with adjustment for a propensity score comprising age, cardiovascular co-morbidities, education, marital status, and pharmacotherapy. We analysed using Cox regression with hazard ratio (HR), and Laplace regression with years until 10% of the patients had died, with 95% confidence intervals (95% CI). Independent variables were prescribed cardiovascular drugs.
Individuals prescribed anticoagulants versus no treatment gained 1.95 years (95% CI 0.47-3.43), anticoagulants versus antiplatelets 1.26 years (95% CI 0.42-2.10), calcium channel blockers 1.17 years (95% CI 0.21-2.14), and statins 1.49 years (95% CI 0.39-2.59). Among patients 80 years or above no significant effect by anticoagulants was seen, HR 0.73 (95% CI 0.43-1.23).
Our findings suggest that life may be prolonged in patients with AF and concomitant CHF in primary care prescribed anticoagulants, calcium channel blockers, and statins.
Notes
Comment In: Scand Cardiovasc J. 2014 Oct;48(5):259-6125228263
PubMed ID
25022789 View in PubMed
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19 records – page 1 of 2.