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DISEASE INTERVENTION COMPARISON RESULTS
J Card Fail. 2007 Jun;13(5):340-5. Controlled Trial (non-randomized)
IN antiarrthythmic drugs, amiodarone, adverse effects, mortality, atrial fibrillation, heart failure The Use of
amiodarone
As Treatment, Chronic
Is worse Than
no amiodarone
To mortality: risk of death due to circulatory failure with amiodarone: HR 1.5
Am J Med. 2007 Oct;120(10):880-5 Randomized Controlled Trial
IN antiarrthythmic drugs, amiodarone, adverse effects, thyroid The Use of
amiodarone
As Treatment, Chronic
Is worse Than
placebo
To alter thyroid function: hypothyroidism developed in 30.8%, hyperthyroidism in 5.3%
JAMA. 2007 Sep 19;298(11):1312-22 Systematic Review
IN antiarrthythmic drugs, amiodarone, clinical indications, adverse effects The Use of
amiodarone
As Treatment, Acute
Is better Than
placebo or no treatment or other antiarrhythmics
To treat atrial fibrillation with left ventricular dysfunction, sustained ventricular arrhythmias, patients about to undergo cardiac surgery, and implantable cardioverter-defibrillators and symptomatic shocks.
Mayo Clin Proc. 2009 Mar;84(3):234-42 Meta-Analysis
IN antiarrthythmic drugs, amiodarone, clinical use, adverse effects, atrial fibrillation, persistent, rhythm control strategy The Use of
amiodarone, low dose, 100 to 200 mg/d
As Treatment, Chronic
Is better Than
placebo
To restore and keep sinus rhythm (21.3% amiodarone vs 9.2% placebo at 1 year) but increase withdrawals by side effects (10.7% per year amiodarone vs 1.9% placebo)
Drugs Aging. 2011 Aug 1;28(8):617-33 Review (Narrative)
IN atrial fibrillation, antiarrthythmic drugs, pharmacology, elderly patients The Use of
most of antiarrhythmic drugs
As Dosage Scheme
Is - Than
with respect to younger patietns
To a reduced dose of most antiarrhythmics should be employed in elder patients (20 to 40% reduction)
Stroke. 2009 Apr;40(4):1410-6 Meta-Analysis
IN atrial fibrillation, anticoagulants, vitamin K antagonists, bleeding risk, elder patients, stroke, ischemic, cerebral infarction, embolic The Use of
age
As Etiologic risk factor
Is useful Than
-
To predict an increased risk of stroke (HR per decade 1.45), major bleeding (HR per decade 1.61) and cardiovascular events (HR per decade 1.45). However the relative benefit of warfarin for preventing stroke persisted, while that of aspirin decreased
Lancet. 2007 Aug 11;370(9586):493-503 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, elderly patients, not high haemorrahgic risk, noT high stroke risk, anticoagulants, vitamin K antagonists, bleeding risk, elder patients The Use of
vitamin K antagonists, warfarin
As Treatment, Chronic
Is better Than
aspirin
To reduce all-type strokes: 1.8% warfarin versus 3.8% aspirin. No increase at all in major haemorrhages.
Heart. 2008 Dec;94(12):1607-13 Meta-Analysis
IN atrial fibrillation, embolic complications, systemic non-cerebral embolism The Use of
vitamin K antagonists, warfarin
As Treatment, Chronic
Is better Than
placebo or antiplatelet agents, aspirin
To reduce systemic embolism: OR 0.5 VS aspirin, OR 0.7 VS placebo. Increased major bleeding: OR 3 VS placebo.
Eur Heart J. 2006 Apr;27(8):949-53. Epub 2006 Mar 9 Cohorts
IN atrial fibrillation, epidemiology The Use of
incidence and prevalence of this arrhythmia
As -
Is useful Than
no comparison here
To plan health interventions concerning this disease: high lifetime risk to develop AF.
Eur Heart J. 2005 Nov;26(22):2422-34. Epub 2005 Oct 4 Descriptive, Cross-Sectional Study
IN atrial fibrillation, epidemiology The Use of
knowing actual current AF management
As Treatment, Chronic
Is useful Than
no comparison here
To consider interventions to improve adherence to guidelines, extract hypothesis to test in future randomized controlled trials
Value Health. 2006 Sep-Oct;9(5):348-56 Descriptive
IN atrial fibrillation, epidemiology, cost The Use of
costs attributable to treating atrial fibrillation
As -
Is - Than
no comparison here
To represents a significant health-care burden
Circulation. 2007 Jun 19;115(24):3050-6 Cohorts
IN atrial fibrillation, lone The Use of
ageing, comorbidities and hypertension on the long term
As Prognostic Item
Is useful Than
-
To modulate progression and complications at 25 years: 31% developped permanent AF, stroke depended on associated risk factors, heart failure was increased, overall mortality was not increased.
J Am Coll Cardiol. 2007 Mar 6;49(9):986-92 Cohorts
IN atrial fibrillation, mortality The Use of
mortality, risk excess associated to AF
As Prognostic Item
Is useful Than
-
To know AF increases risk of death (HR 1,66 compared with general population), specially in the 4 months after diagnosis (HR 9.5)
Am J Med. 2007 Apr;120(4):357-63 Cohorts
IN atrial fibrillation, natural history The Use of
associated risks, first atrial fibrillation as risk marker
As Prognostic Item
Is useful Than
no comparison here
To predict risk of coronary event after diagnosis of AF: 31 per 1000 person-years, 17% at 6 years
Cochrane Database Syst Rev. 2007;(3):CD006186 Systematic Review, Cochrane Review
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
vitamin K antagonists, warfarin
As Treatment, Chronic
Is better Than
aspirin
To reduce all stroke (OR 0.68) and systemic emboli (OR 0.48) but increasing intracranial haemorrhage (OR 1.98). No modification of mortality.
Cochrane Database Syst Rev. 2005 Jul 20;(3):CD001927 Systematic Review, Cochrane Review
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
vitamin K antagonists, warfarin
As Treatment, Chronic
Is better Than
placebo or no treatment at all
To reduce all strokes (ARR 2.5% per year), reduce disabling or fatal stroke (ARR 1.2% per year) and reduce death (OR 0.69)
Ann Intern Med. 2009 Sep 1;151(5):297-305 Cohorts
IN atrial fibrillation, non-valvular The Use of
vitamin K antagonists, warfarin
As Treatment, Chronic
Is better Than
aspirin or no treatment
To obtain an average net clinical benefit of 0.68% per year, which was greater the higher the embolic risk was, icluding elderly patients
Am J Cardiol. 2012 Aug 15;110(4):607-13. doi: 10.1016/j.amjcard.2012.04.034. Epub 2012 May 19 Meta-Analysis
IN atrial fibrillation, paroxysmal, persistent, heart failure The Use of
dronedarone
As Treatment, Chronic
Is worse Than
placebo
To increase all-cause and cardiovascular mortality and increase heart failure exacerbations
Circulation. 2009 Sep 29;120(13):1174-80 Randomized Controlled Trial
IN atrial fibrillation, paroxysmal, persistent, StudyID: ATHENA 2009, subordinated publication The Use of
dronedarone
As Treatment, Chronic
Is better Than
placebo
To reduce annual risk of stroke (all types): 1.2% dronedarone VS 1.8% placebo
JAMA. 2008 Oct 15;300(15):1784-92 Randomized Controlled Trial
IN atrial fibrillation, paroxysmal, recurrent The Use of
continuous amiodarone, after electrical cardioversion
As Treatment, Chronic
Is better Than
amiodarone, episodic treatment, 1 month peri-electrical cardioversion
To reduce major events (either drug- or heart-related): 35% episodic VS 33% continouous amiodarone. All-cause mortality and cardiovascular hospitalizations were higher among those receiving episodic treatment (53% VS 34% continuous)
N Engl J Med. 2004 Dec 2;351(23):2384-91 Clinical Trial (non-controlled, non-randomized)
IN atrial fibrillation, paroxysmal, recurrent, mild or no cardiopathy The Use of
pill-in-the-pocket approach: self-administered oral loading of flecainide or propafenone
As Treatment, Chronic
Is useful Than
historical comparison
To reduce presumed AF recurrences, at 1.5 years (treatment successful in 84% of palpitations episodes), reducing emergency deparment visits, with 7% adverse events (1.5% severe)
N Engl J Med. 2010 Apr 15;362(15):1363-73 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, permanent, rate control strategy The Use of
lenient rate control (resting heart rate <110 beats/min)
As Treatment, Chronic
Is equal Than
strict rate control (resting heart rate <80 beats/min and during moderate exercise <110 beats/min)
To modify at 2 years a composite of cardiovascular events: 12.9% lenient VS 14.9% strict (NS). Symptoms and adverse effects were also similar.
Heart. 2008 Feb;94(2):191-6. Epub 2007 May 4 Cohorts
IN atrial fibrillation, persistent The Use of
digitalis, digoxin
As Treatment, Chronic
Is worse Than
other rate control drugs
To modify mortality: 6.5% digitalis VS 4.1% non-digitalis, HR 1.53 after adjustement for other risk factors
JAMA. 2005 Feb 9;293(6):690-8 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, persistent, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
anticoagulants, direct thrombin inhibitors, ximelagatran
As Treatment, Chronic
Is equal Than
warfarin
To prevent, at 20 months, stroke (of any type): 1.6% xime. VS 1.2% warf. Elevated liver enzymes (>3N): 6% xime. VS 0.8% warf. Major and minor bleeding combined fewer with xime. (37%) than warf. (47%) but not major bleeding alone.
N Engl J Med. 2011 Dec 15;365(24):2268-76 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, persistent, rate control, pharmacologic, Study ID: PALLAS 2011 The Use of
dronedarone
As Treatment, Chronic
Is worse Than
placebo
To modify cardiovascular events: dronedarone increased deaths from cardiovascular causes (HR 2.1), stroke (HR 2.3) and heart failure (HR 1.8)
Am J Med. 2006 May;119(5):448.e1-19 Systematic Review
IN atrial fibrillation, rate control strategy, functional status The Use of
rhythm control strategy (various antiarrhythmics)
As Treatment, Chronic
Is better Than
rate control strategy
To to improve quatily of life: 3 of 4 RCTs found a better improvement in QoL with rate control. Not compared patients in whom SR was restored with those in persistent AF.
Circulation. 2008 Mar 25;117(12):1518-25 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, recent onset The Use of
vernakalant
As Treatment, Acute
Is better Than
placebo
To acute, rapid cardioversion to sinus rhythm: 38 to 52 % vernakalant VS 3 to 4% placebo.
J Am Coll Cardiol. 2009 Sep 15;54(12):1089-95 Meta-Analysis
IN atrial fibrillation, recurrent The Use of
dronedarone
As Treatment, Chronic
Is worse Than
amiodarone, placebo
To prevent AF recurrences: OR 0.79 non-significant VS placebo, OR amiodarone VS dronedarone 0.49 significant) However, amiodarone had more withdrawals due to side effects (OR 1.81 significant)
N Engl J Med. 2009 May 14;360(20):2066-78 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, stroke, ischemic, embolic The Use of
clopidogrel (75 mg/day) plus aspirin
As Treatment, Chronic
Is better Than
aspirin alone
To reduce major cardiovascular events, specially stroke (6.8% clopidogrel+aspirin VS 7.6% aspirin) but increased major haemorrhage (2% clopidogrel+aspirin VS 1.3% aspirin)
Stroke. 1996 Oct;27(10):1760-4 Cohorts
IN stroke, ischemic, cerebral infarction, embolic, atrial fibrillation The Use of
being an embolic stroke due to atrial fibrillation
As Prognostic Item
Is worse Than
arterial stroke not associated to atrial fibrillation
To mortality was higher (25% vs 14% in patients without AF) and moderate to severe disability were more frequent when stroke was associated to AF.