Europace Advance Access originally published online on February 7, 2008
Europace 2008 10(4):395-402; doi:10.1093/europace/eun011
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AFN MORTALITY AND THERAPY
Atrial fibrillation pharmacotherapy after hospital discharge between 1995 and 2004: a shift towards beta-blockers
1 Department of Cardiology, Bispebjerg University Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark; 2 Department of Medicine, Sygehus Øst Køge, Denmark; 3 Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark; 4 National Institute of Public Health, Copenhagen, Denmark; 5 Department of Cardiology, The Heart Centre, Rigshospitalet–Copenhagen University Hospital, Denmark; 6 Department of Pharmacology, Rigshospitalet–Copenhagen University Hospital, Denmark; 7 Department of Public Health, University of Copenhagen, Copenhagen, Denmark
Aims: To study evolvement in pharmacotherapy of atrial fibrillation from 1995 to 2004.
Methods and results: All Danish patients were discharged following first-time atrial fibrillation and their pharmacotherapy was identified by individual-level-linkage of nationwide registers of hospitalization and drug dispensing from pharmacies. A total of 108 791 patients survived 30 days after discharge and were included. In 1995–1996, 7.4% of the patients received beta-blockers, increasing to 44.3% in 2003–2004. The corresponding figures for amiodarone were 2.9 and 5.4%. In contrast, use of nondihydropyridine calcium-channel blockers, digoxin, sotalol, and class 1C antiarrhythmics decreased from 20.6, 63.9, 21.3, and 4.0% in 1995–1996 to 12.6, 43.8, 4.2, and 1.3% in 2003–2004, respectively. Notably, patients receiving anticoagulants increased from 29.8 to 43.5%. Multivariate logistic regression analysis revealed females to be associated with more use of digoxin, but less use of amiodarone and oral anticoagulants than males. Patients above 80 years received less pharmacotherapy, apart from digoxin treatment that was more commonly used in elderly.
Conclusion: Pharmacotherapy of atrial fibrillation has changed towards increased beta-blocker use with a coincident decrease in the use of other rate-limiting drugs and sotalol. Treatment with amiodarone or class 1C antiarrhythmics remained very low. Oral anticoagulant therapy increased considerably, but women and elderly were apparently undertreated.
Key Words: Atrial fibrillation, Epidemiology, Pharmacotherapy, Temporal trends
* Corresponding author. Tel: +45 35 31 33 28; fax: +45 39 75 18 03. E-mail address: mlh{at}heart.dk
Manuscript submitted 11 September 2007. Accepted after revision 6 January 2008.
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