Medical University of South Carolina, Charleston, SC (M.E.F.).
Duke Clinical Research Institute (D.N.H., R.A.M., J.P.P.), Durham, NC.
Circ Arrhythm Electrophysiol. 2021 Feb;14(2):e008961. doi: 10.1161/CIRCEP.120.008961. Epub 2021 Jan 8.
Antiarrhythmic drug (AAD) therapy for atrial fibrillation (AF) can be associated with both proarrhythmic and noncardiovascular toxicities. Practice guidelines recommend tailored AAD therapy for AF based on patient-specific characteristics, such as coronary artery disease and heart failure, to minimize adverse events. However, current prescription patterns for specific AADs and the degree to which these guidelines are followed in practice are unknown.
Patients enrolled in the Get With The Guidelines-Atrial Fibrillation registry with a primary diagnosis of AF discharged on an AAD between January 2014 and November 2018 were included. We analyzed rates of prescription of each AAD in several subgroups including those without structural heart disease. We classified AAD use as guideline concordant or nonguideline concordant based on 6 criteria derived from the American Heart Association/American College of Cardiology/Heart Rhythm Society AF guidelines. Guideline concordance for amiodarone was not considered applicable, since its use is not specifically contraindicated in the guidelines for reasons such as structural heart disease or renal function. We analyzed guideline-concordant AAD use by specific patient and hospital characteristics, and regional and temporal trends.
Among 21 921 patients from 123 sites, the median age was 69 years, 46% female and 51% had paroxysmal AF. The most commonly prescribed AAD was amiodarone (38%). Sotalol (23.2%) and dofetilide (19.2%) were each more commonly prescribed than either flecainide (9.8%) or propafenone (4.8%). Overall guideline-concordant AAD prescription at discharge was 84%. Guideline-concordant AAD use by drug was as follows: dofetilide 93%, sotalol 66%, flecainide 68%, propafenone 48%, and dronedarone 80%. There was variability in rate of guideline-concordant AAD use by hospital and geographic region.
Amiodarone remains the most commonly prescribed AAD for AF followed by sotalol and dofetilide. Rates of guideline-concordant AAD use were high, and there was significant variability by specific drugs, hospitals, and regions, highlighting opportunities for additional quality improvement.
抗心律失常药物（AAD）治疗心房颤动（AF）可能与致心律失常和非心血管毒性有关。实践指南建议根据患者的具体特征（如冠状动脉疾病和心力衰竭），为 AF 患者量身定制 AAD 治疗方案，以最大限度地减少不良事件。然而，目前特定 AAD 的处方模式以及这些指南在实践中的遵循程度尚不清楚。
我们纳入了 2014 年 1 月至 2018 年 11 月期间在 Get With The Guidelines-Atrial Fibrillation 登记处登记的、出院时使用 AAD 治疗的原发性 AF 患者。我们分析了在无结构性心脏病的多个亚组中，每种 AAD 的处方率。我们根据美国心脏协会/美国心脏病学院/心律协会 AF 指南中的 6 项标准，将 AAD 使用分为指南一致和非指南一致。由于结构性心脏病或肾功能等原因，胺碘酮的使用并不特别禁忌，因此我们认为其使用不符合指南，因此不考虑胺碘酮的指南一致性。我们分析了特定患者和医院特征、区域和时间趋势对指南一致的 AAD 使用的影响。
在来自 123 个地点的 21921 名患者中，中位年龄为 69 岁，46%为女性，51%为阵发性 AF。最常开的 AAD 是胺碘酮（38%）。索他洛尔（23.2%）和多非利特（19.2%）的处方率均高于氟卡尼（9.8%）或普罗帕酮（4.8%）。出院时整体指南一致的 AAD 处方率为 84%。根据药物，指南一致的 AAD 使用情况如下：多非利特 93%，索他洛尔 66%，氟卡尼 68%，普罗帕酮 48%，决奈达隆 80%。不同医院和地理区域指南一致的 AAD 使用率存在差异。
胺碘酮仍然是 AF 最常开的 AAD，其次是索他洛尔和多非利特。指南一致的 AAD 使用率较高，且不同药物、医院和地区存在显著差异，这突显了进一步提高质量的机会。
