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Trends in Antiarrhythmic Drug Use in Denmark Over 19 Years

  • Christian Bo Poulsen
    Correspondence
    Corresponding author: Tel: +4592406622.
    Affiliations
    Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark

    Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

    Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark
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  • Mads Damkjær
    Affiliations
    Hans Christian Andersen Children´s Hospital, Odense University Hospital, Odense, Denmark
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  • Bo Løfgren
    Affiliations
    Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark

    Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

    Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark

    Department of Medicine, Randers Regional Hospital, Randers, Denmark
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  • Morten Schmidt
    Affiliations
    Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark

    Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark

    Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Published:November 19, 2019DOI:https://doi.org/10.1016/j.amjcard.2019.11.009
      Antiarrhythmic drugs are widely used in the treatment of supraventricular and ventricular arrhythmias. Yet, nationwide long-term utilization trends remain unexplored. We examined 19-year trends in the use of antiarrhythmic drugs in Denmark. Using nationwide prescription data, we obtained information on hospital and primary healthcare use of Class I-V antiarrhythmic drugs from 1999 to 2017. Data was stratified according to sex and age groups. From 1999 to 2017, the total use of antiarrhythmic drugs per 1000 inhabitants/day increased 16% from 36.3 in 1999 to 41.9 in 2017 with peak consumption in 2008 (46.5). In primary healthcare, Class I usage decreased from 0.8 to 0.5 defined daily doses (DDD) per 1000 inhabitants/day, driven by a decreased prescription rate of propafenone (0.4 to 0.1) whereas prescription of flecainide (Class Ic) increased from 0.3 to 0.4 DDD per 1000 inhabitants/day (mainly in men of age 45 to 79 years). Class II usage increased from 15.4 to 33.6 DDD per 1000 inhabitants/day. Class III usage decreased from 2.6 to 1.1 DDD per 1000 inhabitants/day, reflecting reduced prescription rate of sotalol (2.1 to 0.2) whereas amiodarone increased from 0.5 to 0.9 (mainly due to increased prescription among men and women >80 years). Class IV usage declined from 8.6 to 2.8 DDD per 1000 inhabitants/day. Finally, Class V drugs decreased 8.1 to 3.3 DDD per 1000 inhabitants/day. In conclusion, during the past 2 decades considerable changes in prescription rate of antiarrhythmic drugs have occurred, most notably a reduction in sotalol and increased usage of flecainide, Class II drugs, and amiodarone.
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