1. Incidence of thyroid dysfunction following initiation of amiodarone treatment in patients with and without heart failure: a nationwide cohort study.
- Author
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Ali SA, Ersbøll M, Vinding NE, Butt JH, Rørth R, Selmer C, Westergaard LM, Mogensen UM, Weeke PE, Jøns C, Gustafsson F, Fosbøl E, Køber L, and Kristensen SL
- Subjects
- Humans, Incidence, Cohort Studies, Anti-Arrhythmia Agents adverse effects, Amiodarone adverse effects, Hypothyroidism diagnosis, Thyroid Diseases chemically induced, Thyroid Diseases diagnosis, Thyroid Diseases epidemiology, Heart Failure diagnosis, Heart Failure epidemiology
- Abstract
Aims: Thyroid dysfunction is considered the most frequent complication to amiodarone treatment, but data on its occurrence outside clinical trials are sparse. The present study aimed to examine the incidence of thyroid dysfunction following initiation of amiodarone treatment in a nationwide cohort of patients with and without heart failure (HF)., Methods and Results: In Danish registries, we identified all patients with first-time amiodarone treatment during the period 2000-18, without prior thyroid disease or medication. The primary outcome was a composite of thyroid diagnoses and initiation of thyroid drugs. Outcomes were assessed at 1-year follow-up, and for patients free of events in the first year, in a landmark analysis for the subsequent 5 years. We included 43 724 patients with first-time amiodarone treatment, of whom 16 939 (38%) had HF. At 1-year follow-up, the cumulative incidence and adjusted hazard ratio (HR) of the primary outcome were 5.3% and 1.37 (95% confidence interval 1.25-1.50) in patients with a history of HF and 4.2% in those without HF (reference). In the 1-year landmark analysis, the subsequent 5-year cumulative incidences and adjusted HRs of the primary outcome were 5.3% (reference) in patients with 1-year accumulated dose <27.38 g [corresponding to average daily dose (ADD <75 mg)], 14.0% and HR 2.74 (2.46-3.05) for 27.38-45.63 g (ADD 75-125 mg), 20.0% and HR 4.16 (3.77-4.59) for 45.64-63.88 g (ADD 126-175 mg), and 24.5% and HR 5.30 (4.82-5.90) for >63.88 g (ADD >175 mg)., Conclusion: Among patients who initiated amiodarone treatment, around 5% had thyroid dysfunction at 1-year follow-up, with a slightly higher incidence in those with HF. A dose-response relationship was observed between the 1-year accumulated amiodarone dose and the subsequent 5-year cumulative incidence of thyroid dysfunction., Competing Interests: Conflict of interest: J.H.B. received advisory board honoraria from Bayer, unrelated to the submitted work. E.F. received an independent research grant from Novo Nordisk Foundation, unrelated to the submitted work. L.K. received speaker’s honoraria from Novo, Novartis, AstraZeneca, and Boehringer, unrelated to the submitted work. S.L.K. received a speaker’s honoraria from Astra Zeneca outside of the submitted work. All remaining authors have declared no conflicts of interest., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.)
- Published
- 2023
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