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Dronedarone Versus ...
Dronedarone Versus Sotalol in Antiarrhythmic Drug-Naive Veterans With Atrial Fibrillation
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- Pundi, Krishna (författare)
- Stanford University School of Medicine
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- Fan, Jun (författare)
- VA Palo Alto Health Care System
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- Kabadi, Shaum (författare)
- Sanofi S.A., France
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- Din, Natasha (författare)
- VA Palo Alto Health Care System
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- Blomström-Lundqvist, Carina (författare)
- Örebro University
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- Camm, A. John (författare)
- St George's, University of London
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Kowey, Peter (författare)
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- Singh, Jagmeet P. (författare)
- Harvard Medical School
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- Rashkin, Jason (författare)
- Sanofi S.A., France
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- Wieloch, Mattias (författare)
- Lund University,Lunds universitet,Klinisk koagulationsmedicin, Malmö,Forskargrupper vid Lunds universitet,Clinical Coagulation, Malmö,Lund University Research Groups,Skåne University Hospital,Sanofi AB
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- Turakhia, Mintu P. (författare)
- Stanford University School of Medicine
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- Sandhu, Alexander T. (författare)
- Stanford University School of Medicine
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(creator_code:org_t)
- 2023
- 2023
- Engelska 12 s.
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Ingår i: Circulation: Arrhythmia and Electrophysiology. - 1941-3149. ; 16:8, s. 456-467
- Relaterad länk:
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http://dx.doi.org/10...
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https://lup.lub.lu.s...
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https://doi.org/10.1...
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Abstract
Ämnesord
Stäng
- BACKGROUND: Sotalol and dronedarone are both used for maintenance of sinus rhythm for patients with atrial fibrillation. However, while sotalol requires initial monitoring for QT prolongation and proarrhythmia, dronedarone does not. These treatments can be used in comparable patients, but their safety and effectiveness have not been compared head to head. Therefore, we retrospectively evaluated the effectiveness and safety using data from a large health care system. METHODS: Using Veterans Health Administration data, we identified 11 296 antiarrhythmic drug-naive patients with atrial fibrillation prescribed dronedarone or sotalol in 2012 or later. We excluded patients with prior conduction disease, pacemakers or implantable cardioverter-defibrillators, ventricular arrhythmia, cancer, renal failure, liver disease, or heart failure. We used natural language processing to identify and compare baseline left ventricular ejection fraction between treatment arms. We used 1:1 propensity score matching, based on patient demographics, comorbidities, and medications, and Cox regression to compare strategies. To evaluate residual confounding, we performed falsification analysis with nonplausible outcomes. RESULTS: The matched cohort comprised 6212 patients (3106 dronedarone and 3106 sotalol; mean [±SD] age, 71±10 years; 2.5% female; mean [±SD] CHA2DS2-VASC, 2±1.3). The mean (±SD) left ventricular ejection fraction was 55±11 and 58±10 for dronedarone and sotalol users, correspondingly. Dronedarone, compared with sotalol, did not demonstrate a significant association with risk of cardiovascular hospitalization (hazard ratio, 1.03 [95% CI, 0.88-1.21]) or all-cause mortality (hazard ratio, 0.89 [95% CI, 0.68-1.16]). However, dronedarone was associated with significantly lower risk of ventricular proarrhythmic events (hazard ratio, 0.53 [95% CI, 0.38-0.74]) and symptomatic bradycardia (hazard ratio, 0.56 [95% CI, 0.37-0.87]). The primary findings were stable across sensitivity analyses. Falsification analyses were not significant. CONCLUSIONS: Dronedarone, compared with sotalol, was associated with a lower risk of ventricular proarrhythmic events and conduction disorders while having no difference in risk of incident cardiovascular hospitalization and mortality. These observational data provide the basis for prospective efficacy and safety trials.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Nyckelord
- atrial fibrillation
- dronedarone
- heart failure
- hospitalization
- propensity score
- retrospective studies
Publikations- och innehållstyp
- art (ämneskategori)
- ref (ämneskategori)
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Pundi, Krishna
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Fan, Jun
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Kabadi, Shaum
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Din, Natasha
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Blomström-Lundqv ...
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Camm, A. John
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Kowey, Peter
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Singh, Jagmeet P ...
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Rashkin, Jason
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Wieloch, Mattias
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Turakhia, Mintu ...
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Sandhu, Alexande ...
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- Om ämnet
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- MEDICIN OCH HÄLSOVETENSKAP
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MEDICIN OCH HÄLS ...
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och Klinisk medicin
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och Kardiologi
- Artiklar i publikationen
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Circulation: Arr ...
- Av lärosätet
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Lunds universitet