Uncertainty persists about the safety and efficacy of amiodarone for the management of heart failure.
Methods and Results
We randomized 3029 patients with chronic heart failure to receive carvedilol or metoprolol and followed patients for a median of 58 months. One hundred fifty-five of 1466 patients in New York Heart Association (NYHA) Class II and 209 of 1563 in Class III or IV received amiodarone at baseline. Persistence with amiodarone treatment was high and 66% received amiodarone after 4 years. During follow-up, 38.7% and 58.9% of patients receiving amiodarone in NYHA Classes II and III + IV died versus 26.2% and 43.3% not receiving amiodarone (P < .001). This difference was maintained in multivariable analysis (hazard ratio [HR] 1.5, 95% confidence interval [CI] 1.2–1.7, P < .001). The difference was explained by an increased risk of death due to circulatory failure (HR 2.4, CI 1.9–3.1, P < .001) in patients receiving amiodarone. Sudden death was not different (HR 1.07, CI 0.8–1.4, P = .7). The increased risk was similar across NYHA classes with HR of 1.60 (CI 1.2–2.1, P < .001) in NYHA Class II versus 1.58 (CI 1.3–1.9, P < .001) in Classes III + IV.
Treatment with amiodarone was associated with an increased risk of death from circulatory failure independent of functional class.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Cardiac Failure
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 guidelines for the management of patients with atrial fibrillation) developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.Europace. 2006; 8: 651-745
- Randomized trial of low dose amiodarone in severe congestive heart failure.Lancet. 1994; 344: 493-498
- Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia. Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure.N Engl J Med. 1995; 333 ([comments]): 77-82
- Amiodarone or an Implantable Cardioverter-Defibrillator for Congestive Heart Failure.N Engl J Med. 2005; 352: 225-237
- Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial.Lancet. 2003; 362: 7-13
- Rationale and design of the carvedilol or metoprolol European trial in patients with chronic heart failure: COMET.Eur J Heart Fail. 2002; 4: 321-329
- Effects of metoprolol and carvedilol on cause-specific mortality and morbidity in patients with chronic heart failure—COMET.Am Heart J. 2005; 149: 370-376
- Randomised trial of effect of amiodarone on mortality in patients with left-ventricular dysfunction after recent myocardial infarction: EMIAT. European Myocardial Infarct Amiodarone Trial Investigators.Lancet. 1997; 349: 667-674
- Randomised trial of outcome after myocardial infarction in patients with frequent or repetitive ventricular premature depolarisations: CAMIAT. Canadian Amiodarone Myocardial Infarction Arrhythmia Trial Investigators.Lancet. 1997; 349: 675-682
- Effect of amiodarone on clinical status and left ventricular function in patients with congestive heart failure. CHF-STAT Investigators.Circulation. 1996; 93: 2128-2134
- Impact of concurrent amiodarone treatment on the tolerability and efficacy of carvedilol in patients with chronic heart failure.Heart. 1999; 82: 589-593
- Amiodarone interaction with beta-blockers: analysis of the merged EMIAT (European Myocardial Infarct Amiodarone Trial) and CAMIAT (Canadian Amiodarone Myocardial Infarction Trial) databases. The EMIAT and CAMIAT Investigators.Circulation. 1999; 99: 2268-2275
Accepted: February 28, 2007
Received in revised form: February 23, 2007
Received: October 26, 2006Copenhagen, Denmark; Brescia, Italy; Nottingham, United Kingdom; Basel, Switzerland; Heidelberg, Germany; Paris, France; Kingston upon Hull, United Kingdom; Rhoon, Netherlands; Göteborg, Sweden; London, United Kingdom
© 2007 Elsevier Inc. Published by Elsevier Inc. All rights reserved.