Risk of mortality associated with sotalol and amiodarone for new-onset post-operative atrial fibrillation following CABG
Notice bibliographique
Résumé
Background: Sotalol and amiodarone are commonly prescribed antiarrhythmics for the treatment of post-operative atrial fibrillation (POAF), a common occurrence following coronary artery bypass graft (CABG) surgery. Though they have been shown to be effective in maintaining sinus rhythm in this population, little is known about their association with mortality.Objectives: To examine the association between sotalol and amiodarone exposure and total mortality in individuals with new-onset POAF following CABG.Methods: The linked computerised health databases of Quebec, Canada were used to identify all patients over 65 who had undergone CABG surgery and were newly diagnosed with POAF between January 1, 1993 and June 30, 2003. A nested-case-control approach was used with controls matched by cohort entry month and year. Current users of sotalol and amiodarone were compared to those who were not exposed to either medication during the same period. Rate ratios of mortality were estimated using conditional logistic regression. Due to the non-randomized study design, results were adjusted for potential confounders.Results: 4,770 patients meeting our entrance criteria were identified consisting of 930 cases and 4648 matched controls. Mean follow up time for cases and controls was 3.9 years. Sotalol users were healthier than amiodarone users at baseline, having fewer comorbidities and using fewer concomitant medications. Current users of sotalol were at decreased risk of mortality compared to individuals not exposed to either study drug during the same period (RRadj. 0.56 (0.39, 0.80)). Compared to individuals not currently exposed to either study drug, current users of amiodarone were at increased risk of mortality (RRadj. 1.50 (1.15, 1.94)). However this mortality association was not consistently observed across all sensitivity and subgroup analyses. In one sensitivity analysis, future cardiovascular hospitalizations were not associated with current sotalol exposure (RRadj. 1.07 (0.91, 1.27)) but were increased with amiodarone (RRadj. 1.31 (1.09, 1.57)).Conclusions: Current use of sotalol was associated with a decreased risk of mortality but was not associated with a reduced risk of cardiovascular hospitalisation. Amiodarone was associated with an increased risk of mortality but not for all subgroups and an increased risk of cardiovascular hospitalisation. Additional research is required to more completely and reliably assess the safety of sotalol and amiodarone in individuals with POAF.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».