Li Weijia, Wang Yu-Chiang, Tiwari Nidhish, Di Biase Luigi
Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY, USA.
Montefiore Medical Center, The Bronx, NY, USA.
J Interv Card Electrophysiol. 2022 Jan;63(1):207-214. doi: 10.1007/s10840-021-00970-8. Epub 2021 Feb 26.
Amiodarone is commonly used in atrial fibrillation (AF). Long-term use of amiodarone is associated with significant toxicities especially in elderly patients. However, in the short term after hospitalization of AF, it remains uncertain whether the use of amiodarone will increase mortality. We aim to investigate whether Amiodarone affects short-term mortality in elderly patients after hospitalization for atrial fibrillation.
We conducted a single-center retrospective cohort study including patients (Age > = 60 years old) who were hospitalized between 07/01/2004 and 06/30/2019 with primary diagnosis of AF and left ventricular ejection fraction (LVEF) > = 50%. Patients who were prescribed amiodarone during hospitalization but not before hospitalization are classified into Amiodarone group (341 patients). Patients who were not prescribed amiodarone are classified into non-amiodarone group (2171 patients). Propensity score matching was performed with 1:1 nearest-neighbor matching of Amiodarone group and Non-amiodarone group based on baseline variables. Univariate and Multivariate logistic regression were used to calculate the odds ratio of amiodarone use on in-hospital mortality, and multivariate cox regression was adopted to calculate the hazard ratio of amiodarone use on 100-day mortality.
Patients' baseline demographic and clinical characteristics were well matched in both groups. Both univariate and multivariate logistic regression showed amiodarone group had higher in-hospital mortality (OR 10.27, p = 0.0268; 16.50, p = 0.0171) than non-amiodarone group and multivariate Cox regression suggested increased 100-day all-cause mortality (HR 2.34, p = 0.022).
Amiodarone use in elderly patients with preserved ejection fraction is associated with increased in-hospital and 100-day all-cause mortality after hospitalization for AF.
胺碘酮常用于心房颤动（AF）。长期使用胺碘酮会带来显著毒性，尤其是在老年患者中。然而，在房颤患者住院后的短期内，使用胺碘酮是否会增加死亡率仍不确定。我们旨在研究胺碘酮是否会影响老年房颤患者住院后的短期死亡率。
我们进行了一项单中心回顾性队列研究，纳入了2004年7月1日至2019年6月30日期间住院，初步诊断为房颤且左心室射血分数（LVEF）≥50%的患者（年龄≥60岁）。住院期间但非住院前开具胺碘酮处方的患者被分为胺碘酮组（341例患者）。未开具胺碘酮处方的患者被分为非胺碘酮组（2171例患者）。基于基线变量，对胺碘酮组和非胺碘酮组进行1:1最近邻匹配的倾向评分匹配。使用单因素和多因素逻辑回归计算使用胺碘酮对院内死亡率的比值比，并采用多因素Cox回归计算使用胺碘酮对100天死亡率的风险比。
两组患者的基线人口统计学和临床特征匹配良好。单因素和多因素逻辑回归均显示，胺碘酮组的院内死亡率高于非胺碘酮组（OR 10.27，p = 0.0268；16.50，p = 0.0171），多因素Cox回归提示100天全因死亡率增加（HR 2.34，p = 0.022）。
在射血分数保留的老年患者中，使用胺碘酮与房颤住院后的院内和100天全因死亡率增加相关。
