National Trends in Antiarrhythmic and Antithrombotic Medication Use in Atrial Fibrillation

Abstract

Atrial fibrillation (AF) is the most common significant cardiac arrhythmia, affecting an estimated 2.3 million adults in the United States. Its prevalence is increasing, particularly in older persons, and roughly 10% of persons aged 80 years or older are affected.^1,2 Pharmacologic management traditionally had been directed toward 3 goals: control of rapid ventricular rate, restoration and maintenance of sinus rhythm, and prevention of thromboembolic complications.³ Medical therapy has been shown to ameliorate several of the complications associated with AF, particularly with regard to reducing stroke risk.⁴ Atrial fibrillation has increasingly been the focus of clinical trials and practice guidelines, but it is unclear whether recent clinical practice has changed in accord with published recommendations. We analyzed National Ambulatory Medical Care Survey (NAMCS) data from 1991 through 2000 to assess trends in the prescribing behavior of US office-based physicians in the management of AF. We hypothesized that digoxin use would decline, being replaced by increasing use of β-blockers and calcium channel blockers. We also expected a growing interest in the use of medications for sinus rhythm maintenance, in particular, newer agents such as amiodarone hydrochloride and sotalol hydrochloride. Finally, we expected anticoagulant use to increase over time, especially in patients at the highest risk for stroke.