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Efficacy and safety of dronedarone by atrial fibrillation history duration : Insights from the ATHENA study

Blomström-Lundqvist, Carina ; Marrouche, Nassir ; Connolly, Stuart ; Corp dit Genti, Valérie ; Wieloch, Mattias LU ; Koren, Andrew and Hohnloser, Stefan H. (2020) In Clinical Cardiology 43(12). p.1469-1477
Abstract

Background: Atrial fibrillation/atrial flutter (AF/AFL) burden increases with increasing duration of AF/AFL history. Hypothesis: Outcomes with dronedarone may also be impacted by duration of AF/AFL history. Methods: In this post hoc analysis of ATHENA, efficacy and safety of dronedarone vs placebo were assessed in groups categorized by time from first known AF/AFL episode to randomization (ie, duration of AF/AFL history): <3 months (short), 3 to <24 months (intermediate), and ≥ 24 months (long). Results: Of 2859 patients with data on duration of AF/AFL history, 45.3%, 29.6%, and 25.1% had short, intermediate, and long histories, respectively. Patients in the long history group had the highest prevalence of structural heart disease... (More)

Background: Atrial fibrillation/atrial flutter (AF/AFL) burden increases with increasing duration of AF/AFL history. Hypothesis: Outcomes with dronedarone may also be impacted by duration of AF/AFL history. Methods: In this post hoc analysis of ATHENA, efficacy and safety of dronedarone vs placebo were assessed in groups categorized by time from first known AF/AFL episode to randomization (ie, duration of AF/AFL history): <3 months (short), 3 to <24 months (intermediate), and ≥ 24 months (long). Results: Of 2859 patients with data on duration of AF/AFL history, 45.3%, 29.6%, and 25.1% had short, intermediate, and long histories, respectively. Patients in the long history group had the highest prevalence of structural heart disease and were more likely to be in AF/AFL at baseline. Placebo-treated patients in the long history group also had the highest incidence of AF/AFL recurrence and cardiovascular (CV) hospitalization during the study. The risk of first CV hospitalization/death from any cause was lower with dronedarone vs placebo in patients with short (hazard ratio, 0.79 [95% confidence interval: 0.65-0.96]) and intermediate (0.72 [0.56-0.92]) histories; a trend favoring dronedarone was also observed in patients with long history (0.84 [0.66-1.07]). A similar pattern was observed for first AF/AFL recurrence. No new drug-related safety issues were identified. Conclusions: Patients with long AF/AFL history had the highest burden of AF/AFL at baseline and during the study. Dronedarone significantly improved efficacy vs placebo in patients with short and intermediate AF/AFL histories. While exploratory, these results support the potential value in initiating rhythm control treatment early in patients with AF/AFL.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
antiarrhythmic therapy, atrial fibrillation, atrial flutter, dronedarone, duration of atrial fibrillation history
in
Clinical Cardiology
volume
43
issue
12
pages
9 pages
publisher
Wiley-Blackwell
external identifiers
  • scopus:85092936022
  • pmid:33080088
ISSN
0160-9289
DOI
10.1002/clc.23463
language
English
LU publication?
yes
id
48af0527-d2b0-4705-989d-d62ad159b9af
date added to LUP
2020-11-12 07:46:49
date last changed
2024-05-31 01:34:45
@article{48af0527-d2b0-4705-989d-d62ad159b9af,
  abstract     = {{<p>Background: Atrial fibrillation/atrial flutter (AF/AFL) burden increases with increasing duration of AF/AFL history. Hypothesis: Outcomes with dronedarone may also be impacted by duration of AF/AFL history. Methods: In this post hoc analysis of ATHENA, efficacy and safety of dronedarone vs placebo were assessed in groups categorized by time from first known AF/AFL episode to randomization (ie, duration of AF/AFL history): &lt;3 months (short), 3 to &lt;24 months (intermediate), and ≥ 24 months (long). Results: Of 2859 patients with data on duration of AF/AFL history, 45.3%, 29.6%, and 25.1% had short, intermediate, and long histories, respectively. Patients in the long history group had the highest prevalence of structural heart disease and were more likely to be in AF/AFL at baseline. Placebo-treated patients in the long history group also had the highest incidence of AF/AFL recurrence and cardiovascular (CV) hospitalization during the study. The risk of first CV hospitalization/death from any cause was lower with dronedarone vs placebo in patients with short (hazard ratio, 0.79 [95% confidence interval: 0.65-0.96]) and intermediate (0.72 [0.56-0.92]) histories; a trend favoring dronedarone was also observed in patients with long history (0.84 [0.66-1.07]). A similar pattern was observed for first AF/AFL recurrence. No new drug-related safety issues were identified. Conclusions: Patients with long AF/AFL history had the highest burden of AF/AFL at baseline and during the study. Dronedarone significantly improved efficacy vs placebo in patients with short and intermediate AF/AFL histories. While exploratory, these results support the potential value in initiating rhythm control treatment early in patients with AF/AFL.</p>}},
  author       = {{Blomström-Lundqvist, Carina and Marrouche, Nassir and Connolly, Stuart and Corp dit Genti, Valérie and Wieloch, Mattias and Koren, Andrew and Hohnloser, Stefan H.}},
  issn         = {{0160-9289}},
  keywords     = {{antiarrhythmic therapy; atrial fibrillation; atrial flutter; dronedarone; duration of atrial fibrillation history}},
  language     = {{eng}},
  number       = {{12}},
  pages        = {{1469--1477}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Clinical Cardiology}},
  title        = {{Efficacy and safety of dronedarone by atrial fibrillation history duration : Insights from the ATHENA study}},
  url          = {{http://dx.doi.org/10.1002/clc.23463}},
  doi          = {{10.1002/clc.23463}},
  volume       = {{43}},
  year         = {{2020}},
}