The latest guidance published by the National Institute for Health and Clinical Excellence (NICE) recommends the use of dronedarone as a second-line treatment in people with additional cardiovascular risk factors whose atrial fibrillation (AF) has not been controlled by first-line therapy (usually including beta-blockers).
The guidance also suggests the use of dronedarone for those who have at least one of the following cardiovascular risk factors:
– hypertension requiring drugs of at least two different classes
– diabetes mellitus
– previous transient ischaemic attack, stroke or systemic embolism
– left atrial diameter of 50 mm or greater
– left ventricular ejection fraction less than 40% (noting that the summary of product characteristics [SPC] does not recommend dronedarone for people with left ventricular ejection fraction less than 35% because of limited experience of using it in this group) or
– age 70 years or older, and
– who do not have unstable New York Heart Association (NYHA) class III or IV heart failure1.
In recommending the use of dronedarone as a treatment option for some people with AF, the independent Appraisal Committee noted comments from patients and clinical experts received during consultation on the draft guidance that all current anti-arrhythmic drugs have side effects which can have a significant impact on quality of life with long term use. It heard from patient experts that some people with atrial fibrillation might prefer to take dronedarone because it has fewer side effects, despite it being less effective than other antiarrhythmic drugs in preventing recurrence of atrial fibrillation. The committee also accepted evidence that the drug did not lead to an increase in the risk of mortality, unlike the anti-arrhythmics with which it was compared.
Atrial fibrillation is one of the most common heart rhythm disturbance conditions. It can cause symptoms such as palpitations and tiredness and is associated with an increased risk of thrombus (blood clot) formation and thromboembolism including ischaemic strokes. The prevalence of AF increases with age and in the UK nearly 50,000 new cases of AF are diagnosed each year. Standard baseline therapy for AF may include drugs to maintain sinus rhythm, where beta-blockers are usually the first choice.
For more information on the guidelines, please visit the NICE website.
N.B.
The New York Heart Association classification of heart failure relates symptoms to everyday activities and the patient’s quality of life. Class III indicates a marked limitation of physical activity and class IV indicates being unable to carry out any physical activity without discomfort.
