The following is a summary of “SAFETY OF PROPAFENONE VERSUS AMIODARONE IN CORONARY ARTERY DISEASE AND HEART FAILURE,” published in the March 2023 issue of Cardiology by Lin, et al.
Previous research has cautioned against using class IC antiarrhythmic drugs in patients with structural heart disease due to an increased risk of death. However, the safety of propafenone, specifically in patients with coronary artery disease or heart failure remains uncertain.
The study included 62,190 eligible patients with coronary artery disease or heart failure between 2002 and 2017. Patients were stratified into two groups, propafenone users (n=20,730) and amiodarone users (n=41,460), and clinical outcomes were compared using Cox proportional hazard regression. After propensity score matching, baseline characteristics were comparable between the two groups.
During a mean follow-up of 6.3 years, propafenone use was associated with a lower risk of all-cause mortality compared to amiodarone use (adjusted hazard ratio [HR]: 0.43; 95% CI: 0.41-0.44; P=<0.001). Death due to arrhythmia was also lower in propafenone users (adjusted HR: 0.65; 95% CI: 0.50-0.85; P=0.002). Subgroup analysis for all clinical outcomes showed similar trends favoring propafenone users.
Therefore, the study suggested that the use of propafenone in patients with coronary artery disease or heart failure did not increase the risk of mortality compared to amiodarone in real-world settings.
Reference: jacc.org/doi/10.1016/S0735-1097%2823%2900446-1
