Risk of mortality associated with sotalol and amiodarone for new-onset post-operative atrial fibrillation following CABG
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".