Amiodarone use is associated with increased risk of stroke in patients with nonvalvular atrial fibrillation: a nationwide population-based cohort study

Atrial fibrillation (AF), the most common sustained arrhythmia requiring treatment worldwide, is one of the major causes of ischemic stroke. Although amiodarone is commonly used for rhythm control in AF, its relationship with stroke has rarely been addressed.We evaluated 16,091 patients who were dia...

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Published in:Medicine (Baltimore) 2015-05, Vol.94 (19), p.e849
Main Authors: Chen, Wei-Chun, Chen, Wei-Cheng, Chen, Chih-Yu, Wu, Biing-Ru, Cheng, Wen-Chien, Lin, Kuo-Hung, Hsia, Te-Chun, Chen, Wei, Chen, Chia-Hung, Muo, Chih-Hsin, Liao, Wei-Chih, Li, Chia-Hsiang
Format: Article
Language:English
Subjects:
Age Factors
Aged
Amiodarone - adverse effects
Amiodarone - therapeutic use
Anti-Arrhythmia Agents - adverse effects
Anti-Arrhythmia Agents - therapeutic use
Anticoagulants - therapeutic use
Atrial Fibrillation - drug therapy
Comorbidity
Digoxin - adverse effects
Drug Therapy, Combination
Female
Humans
Male
Middle Aged
Observational Study
Proportional Hazards Models
Risk Factors
Stroke - chemically induced
Taiwan - epidemiology
Warfarin - therapeutic use
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Summary:Atrial fibrillation (AF), the most common sustained arrhythmia requiring treatment worldwide, is one of the major causes of ischemic stroke. Although amiodarone is commonly used for rhythm control in AF, its relationship with stroke has rarely been addressed.We evaluated 16,091 patients who were diagnosed with AF (Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] 427.31 and 427.32) between 1998 and 2011; the date of AF diagnosis was set as the index date. Patients with a history of stroke (ICD-9-CM 430-438) who received amiodarone before the index date or during the following 30 days, or who experienced stroke within 30 days of receiving amiodarone were excluded. Finally, 7548 patients with AF were included in this study and divided into 2 groups according to whether they received amiodarone (Anatomical Therapeutic Chemical code C01BD01) during the study period.The risk of ischemic stroke in AF patients receiving amiodarone was 1.81-fold (95% confidence interval [CI] 1.52-2.16), 1.79-fold (95% CI 1.50-2.14), and 1.78-fold (95% CI 1.49-2.13) higher than in those who did not receive amiodarone, according to crude, Model 1, and Model 2 Cox proportional hazard regression models, respectively. In a demographically stratified analysis, the risk of ischemic stroke was significantly higher in patients aged
ISSN:0025-7974
1536-5964
DOI:10.1097/MD.0000000000000849