Shurrab Mohammed, Koh Maria, Jackevicius Cynthia A, Qiu Feng, Conlon Michael, Caswell Joseph, Tu Karen, Austin Peter C, Ko Dennis T
Cardiology Department, Health Sciences North, Northern Ontario School of Medicine, Laurentian University, Sudbury, Ontario, Canada.
Health Sciences North Research Institute, Sudbury, Ontario, Canada.
Int J Cardiol Heart Vasc. 2021 Apr 29;34:100788. doi: 10.1016/j.ijcha.2021.100788. eCollection 2021 Jun.
Amiodarone and diltiazem are commonly recommended cardiovascular medications for use in atrial fibrillation (AF) patients. They are known to have drug-drug interactions (DDIs) with direct oral anticoagulants (DOACs). We aimed to evaluate frequency of use of amiodarone or diltiazem among continuous users of DOACs in AF patients and to determine factors associated with their co-use.
The study population included all AF patients with continuous DOAC use in Ontario, Canada, ≥66 years, from April 1, 2017 to March 31, 2018. Concurrent use of amiodarone or diltiazem was determined by identifying the presence of an overlapping prescription. Multivariable logistic regression models were used to identify predictors of amiodarone or diltiazem use.
In total, 5,390 AF patients, ≥66 years, with continuous DOAC use were identified. Amiodarone was co-prescribed in 6.4% patients and diltiazem was co-prescribed in 11.2% patients. Prior percutaneous coronary intervention (PCI) and coronary artery bypass surgery (CABG) were associated with significantly increased odds of amiodarone co-use (OR 2.51 [95% CI 1.54, 4.09], p = 0.0002 and OR 5.28 [95% CI 3.52, 7.93], p= <0.001, respectively). Patients with a heart failure (HF) history also had increased co-use of amiodarone (OR 2.05 [95% CI 1.57, 2.67], p < 0.001). The presence of chronic obstructive pulmonary disease (COPD) was associated with significantly increased odds of diltiazem co-use (OR 1.58 [95% CI 1.31, 1.9], p=<0.001).
Among AF patients with continuous DOAC use, amiodarone was co-prescribed in 1 in 16 patients and diltiazem was co-prescribed in 1 in 9 patients. Predictors such as history of HF, PCI, CABG or COPD help identify vulnerable populations at increased risk of DDIs.
胺碘酮和地尔硫䓬是常用于心房颤动（AF）患者的心血管药物。已知它们与直接口服抗凝剂（DOACs）存在药物相互作用（DDIs）。我们旨在评估AF患者中持续使用DOACs的人群中胺碘酮或地尔硫䓬的使用频率，并确定与其联合使用相关的因素。
研究人群包括2017年4月1日至2018年3月31日期间在加拿大安大略省年龄≥66岁且持续使用DOACs的所有AF患者。通过识别重叠处方来确定胺碘酮或地尔硫䓬的同时使用情况。使用多变量逻辑回归模型来识别胺碘酮或地尔硫䓬使用的预测因素。
总共识别出5390例年龄≥66岁且持续使用DOACs的AF患者。6.4%的患者同时开具了胺碘酮，11.2%的患者同时开具了地尔硫䓬。既往经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）与胺碘酮联合使用的几率显著增加相关（OR分别为2.51 [95% CI 1.54, 4.09]，p = 0.0002和OR 5.28 [95% CI 3.52, 7.93]，p < 0.001）。有心力衰竭（HF）病史的患者胺碘酮联合使用情况也有所增加（OR 2.05 [95% CI 1.57, 2.67]，p < 0.001）。慢性阻塞性肺疾病（COPD）的存在与地尔硫䓬联合使用的几率显著增加相关（OR 1.58 [95% CI 1.31, 1.9]，p < 0.001）。
在持续使用DOACs的AF患者中，每16例患者中有1例同时开具了胺碘酮，每9例患者中有1例同时开具了地尔硫䓬。诸如HF、PCI、CABG或COPD病史等预测因素有助于识别发生DDIs风险增加的脆弱人群。
