Amiodarone use in elderly atrial fibrillation patients with preserved ejection fraction is associated with increased short-term mortality

Abstract

Abstract Background 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. Methods We conducted a retrospective cohort study including patients (Age≥60 years old) who were hospitalized between 07/01/2004 and 06/30/2019 with a primary diagnosis of AF and left ventricular ejection fraction (LVEF) ≥50%. Patients who were prescribed amiodarone during hospitalization but not before are considered as amiodarone group (348 patients). Patients who weren't prescribed amiodarone are considered as non-amiodarone group (2260 patients). Univariate analysis solely analyzed amiodarone use on the all-cause mortality (Kaplan-Meier Curve), and possible confounders were adjusted in the multivariate analysis including age, gender, diabetes mellitus (DM), hypertension (HTN), coronary artery disease (CAD), as well as LVEF, left atrium internal diameter, use of other rate control medications (e.g. beta-blocker). The proportional-hazard assumption was tested by Log-rank test and a 2-sided P value of <0.05 is considered statistically significant. The hazard ratio and 95% confidence interval (CI) were calculated. Results Patients' baseline characteristics were listed in Table 1. Both Univariate and Multivariate analysis showed amiodarone group had higher in-hospital (hazard ratio 2.06; p=0.036) and 100-day mortality (hazard ratio 1.86; p=0.028). Other rate control medication use was also associated with increased mortality but not statistically significant. The results are showed in Figure 1. Conclusion Amiodarone use in elderly patients with preserved ejection fraction is associated with increased short-term all-cause mortality after hospitalization of AF. Figure 1. KM Curve & ForestPlot of Mortality Funding Acknowledgement Type of funding source: None