The association between the use of antiarrhythmic drugs in non-valvular atrial fibrillation and patient prognosis using data from the China Atrial Fibrillation (China-AF) registry

Abstract

Background: Results of the landmark Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) trial comparing rhythm control and rate control strategies has led to dramatic changes in the pharmacological management of non-valvular atrial fibrillation (NVAF) patients. We sought to investigate the effect of antiarrhythmic drugs (AADs) on the clinical outcomes of NVAF patients using “real-world” data from China. Material/Methods: We evaluated the association between AAD usage and clinical outcomes using clinical data of 8161 NVAF patients who were AAD-naive before enrollment in the China Atrial Fibrillation Registry, recruited between August 2011 and February 2017. The primary outcome was all-cause mortality. Results: Compared with 6167 patients who never used any AADs, 1994 patients in the AAD group had lower incidence (per 100 person-years) of all-cause mortality (1.44 versus 3.91), cardiovascular death (0.45 versus 2.31), ischemic stroke (1.36 versus 2.03), and cardiovascular hospitalization (9.83 versus 10.22) over a mean follow-up duration of 316.7±90.4 days. After adjusting for potential confounders, AAD usage was associated with a lower risk of all-cause mortality [hazard ratio (HR): 0.50, 95% confidence interval (CI): 0.31–0.81] and decreased risk of cardiovascular death (HR: 0.30, 95% CI: 0.13–0.68). Subgroup analysis revealed AAD was associated with higher risk of cardiovascular hospitalization among female patients. Conclusions: AAD usage was associated with lower risk of 1-year all-cause mortality and cardiovascular death in “real-world” patients with NVAF.