Comparative effectiveness of antiarrhythmic drugs on cardiovascular hospitalization and mortality in atrial fibrillation

Lakdawalla, Darius N.; Turakhia, Mintu P.; Jhaveri, Mehul; Mozaffari, Essy; Davis, Pamela J.; Bradley, Lydia; Solomon,

doi:10.2217/cer.13.19

Cited by 2 publications

(2 citation statements)

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“…Important patient subgroups, including the elderly, and those with coexisting morbidities, are frequently under-represented in clinical trials of cardiovascular drugs [12, 13]. Likewise, AF clinical trial populations vary in their representativeness to real-world AF patients [14, 15]. …”

Section: Introductionmentioning

confidence: 99%

Impact of Dronedarone Treatment on Healthcare Resource Utilization in Patients with Atrial Fibrillation/Flutter

Kim

Lin²,

Jhaveri

et al. 2014

Adv Ther

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BackgroundThe ATHENA (A Placebo-Controlled, Double-Blind, Parallel Arm Trial to Assess the Efficacy of Dronedarone 400 mg bid for the Prevention of Cardiovascular Hospitalization or Death from Any Cause in Patients with Atrial Fibrillation/Atrial Flutter) trial demonstrated a significant reduction (26%) in the rate of first cardiovascular (CV) hospitalization in dronedarone-treated patients with paroxysmal or persistent atrial fibrillation/flutter (AF/AFL). ATHENA was the first trial to demonstrate a CV outcomes benefit, specifically reduced CV hospitalizations, with an antiarrhythmic drug. The objective of this study was to assess the impact of dronedarone treatment on healthcare resource utilization among real-world patients with AF/AFL in United States clinical practice.MethodsThis retrospective cohort study used claims data from the MarketScan® databases (Truven Health, Durham, NC, USA) to identify patients with ≥2 concurrent de novo pharmacy claims for dronedarone (≥180 days’ total supply) between June 2009 and March 2011, and with an AF/AFL diagnosis and no heart failure-related hospitalization during the 12 months preceding the initial (index) dronedarone claim. Annualized inpatient and outpatient resource utilization were compared between the pre-index (baseline) and post-index (follow-up) periods.ResultsIn total, 5,656 AF/AFL patients were prescribed dronedarone for ≥6 months and were followed for mean (standard deviation) 11.9 (4.7) months. Reductions in mean numbers of annualized all-cause, CV- and AF-related hospitalizations (~40–45%), and emergency department visits (~30–45%) were realized. These benefits were offset by increases in office visits (~10–30%) and AF-related prescription claims (74%) after dronedarone initiation. The sub-cohort of patients switching to dronedarone from Prior Rhythm-Control therapy (n = 2,080) showed similar reductions in hospital and emergency department events.ConclusionsThis study suggests that dronedarone use in real-world practice, as in the ATHENA trial, results in substantial reductions in hospital admissions, both in first-line and second-line antiarrhythmic treatment settings.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-014-0108-x) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Impact of Dronedarone Treatment on Healthcare Resource Utilization in Patients with Atrial Fibrillation/Flutter

Kim

Lin²,

Jhaveri

et al. 2014

Adv Ther

Self Cite

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“…21 Reported event rates for stroke, heart failure, and mortality are low; however, the potential benefits of AAD in reducing these events are yet to be established. 2,21,24 The Impact of Antiarrhythmic Drug Therapy on Patients AAD therapy is effective at reducing AF recurrences, 21 controlling symptoms of AF, and improving patient QoL. 25 In the A4 study, paroxysmal AF patients (N=112) treated with AAD showed a 13% reduction in symptom frequency (p=0.002) and a 38% reduction in symptom severity (p<0.0001) as measured by the AF Symptom Frequency and Severity Checklist.…”

Section: Clinical Impact Of Antiarrhythmic Drug Therapymentioning

confidence: 99%

Management of Atrial Fibrillation in Europe: Current Care Pathways and the Clinical Impact of Antiarrhythmic Drugs and Catheter Ablation

et al. 2019

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Atrial fibrillation (AF), the most common form of arrhythmia, increases the risk of heart failure, stroke, and death. Management of AF focusses on effectively and safely controlling irregular heart rhythm, improving symptoms, and reducing complications. Early treatment of AF is important as it may improve patient life expectancy and quality of life (QoL). Current European guidelines recommend an integrated approach to AF management that involves shared decision making between patients and multidisciplinary teams of healthcare professionals to improve access to care and patient compliance. Treatment options include the use of anticoagulants, cardioversion, rate control therapies, and rhythm control therapies. Over the long term, rhythm control strategies that include antiarrhythmic drugs (AAD) and catheter ablation are the most common methods for controlling AF. The objective of this review is to highlight current European AF care pathway management recommendations and to examine the clinical, economic, and patient impact of different treatment options, including AAD and catheter ablation. While AAD have been shown to improve QoL and are affordable in the short term, treatment is moderately effective, associated with significant side effects, and can be costly long term. Catheter ablation is a highly effective therapy choice that improves patient wellbeing and is associated with a low rate of ablation-related complications. Compared to drug therapy, catheter ablation provides a significant reduction in AF burden, reduces rates of recurrence, provides a greater improvement in QoL, and facilitates long-term cost savings.

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Comparative effectiveness of antiarrhythmic drugs on cardiovascular hospitalization and mortality in atrial fibrillation

Abstract: Assessment of the comparative effectiveness of individual AADs on CV hospitalization and mortality end points is not possible with the current evidence.

Cited by 2 publications

References 58 publications

Impact of Dronedarone Treatment on Healthcare Resource Utilization in Patients with Atrial Fibrillation/Flutter

Impact of Dronedarone Treatment on Healthcare Resource Utilization in Patients with Atrial Fibrillation/Flutter

Management of Atrial Fibrillation in Europe: Current Care Pathways and the Clinical Impact of Antiarrhythmic Drugs and Catheter Ablation

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