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. 2013 Nov;166(5):871-8.
doi: 10.1016/j.ahj.2013.08.010. Epub 2013 Sep 24.

Adherence to guideline recommendations for antiarrhythmic drugs in atrial fibrillation

Nancy M Allen LaPointe  1 , Yuliya Lokhnygina, Gillian D Sanders, Eric D Peterson, Sana M Al-Khatib
Affiliations

Adherence to guideline recommendations for antiarrhythmic drugs in atrial fibrillation

Nancy M Allen LaPointe et al. Am Heart J. 2013 Nov.

Abstract

Background: Atrial fibrillation (AF) guideline recommendations for antiarrhythmic drugs (AADs) are based on the effectiveness and safety of the AAD in patients with selected, concomitant heart disease. It is unknown to what extent these recommendations are being implemented in clinical practice.

Methods: Using commercial health claims, patients with AF were identified and then categorized into mutually exclusive, guideline-established subgroups based on their most serious concurrent heart disease: heart failure, coronary artery disease (CAD), hypertension, and no heart disease. Antiarrhythmic drug use after the first AF encounter and the identified concurrent heart disease encounter was determined from prescription claims, and this was compared with guideline recommendations.

Results: From January 2006 through December 2010, a total of 331,274 patients with AF aged < 65 years were identified: 18%, heart failure; 23%, CAD; 33%, hypertension; and 25%, no heart disease. Of these, 78,877 (24%) patients filled ≥ 1 qualifying AAD prescription. The median age was 57 years (interquartile range 52-61), and 69% were male. A total of 74,191 patients had AADs after both the AF and concurrent heart disease encounters: 27% with heart failure, 25% with CAD, 21% with hypertension, and 19% with no heart disease. In the heart failure and CAD subgroups, 45% and 31% of AADs were inconsistent with first- or second-line guideline recommendations, respectively.

Conclusion: More than one-third of the AADs used in patients with AF and CAD or heart failure did not conform to guideline recommendations. This highlights the potential need for increased clinician education and intervention to improve the safe use of AADs for AF management.

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Figures

Figure 1
Figure 1. Proportion of patients identified with AF in each calendar year who subsequently received one or more AADs
AAD indicates antiarrhythmic drug; AF, atrial fibrillation.
Figure 2
Figure 2. Trends in AAD use in overall AF population and by age subgroups
A. Number of patients taking AADs during each calendar quarter per 10,000 patients with AF diagnosis. B. Number of patients aged <60 years taking AADs during each calendar quarter per 10,000 patients aged <60 years with AF diagnosis. C. Number of patients aged 60–64 years taking AADs during each calendar quarter per 10,000 patients aged 60–64 years with AF diagnosis. AF indicates atrial fibrillation; Q, quarter.
Figure 3
Figure 3. AAD use by guideline-specified subgroups
*Underlined/bolded AAD drugs indicate first-line, guideline-recommended drugs. Italicized AAD drugs indicate second-line, guideline-recommended drugs. Patients could have taken one or more AADs (successively, not simultaneously). AAD indicates antiarrhythmic drug; AF, atrial fibrillation; CAD, coronary artery disease; HF, heart failure; HTN, hypertension.
Figure 4
Figure 4. Number of patients taking AADs per 10,000 AF patients with coexisting disease
AAD indicates antiarrhythmic drug; AF, atrial fibrillation; CAD, coronary artery disease; HF, heart failure; HTN, hypertension; Q, quarter; NONE, none of the specified heart diseases.
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