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Doctors are prescribing fewer and safer antiarrhythmic drugs than in the 1980s

Doctors now prescribe antiarrhythmic drugs less often than they did in the 1980s. They are also prescribing fewer class I agents (for example, quinidine, procainamide and mexiletine) in favor of class III agents (for example, amiodarone and sotalol), which are less risky for people who have had heart attacks. However, the change was slow, according to a study by the Duke Center for Education and Research on Therapeutics, which is supported by the Agency for Healthcare Research and Quality (HS10548). Sana M. Al-Khatib, M.D., M.H.S., and fellow researchers used pharmaceutical marketing research data to review outpatient antiarrhythmic drug prescriptions in the United States from 1995 through the third quarter of 2000 to characterize drug prescribing patterns based on diagnosis and physician specialty.

Their review revealed a noticeable decline in the number of class I antiarrhythmic prescriptions (5.5 million in 1995 vs. 2.4 million in 2000). However, until 2000, class I antiarrhythmic drugs remained the most commonly prescribed antiarrhythmic agents (3.6 million class I prescriptions vs. new 3.2 million class III prescriptions in 1999). There was a doubling in the number of class III antiarrhythmic prescriptions in 2000 (2.7 million vs. 1.2 million in 1995), largely due to the increase in amiodarone prescriptions.

Doctors most commonly prescribe antiarrhythmic drugs for atrial fibrillation, a type of irregular and often rapid heartbeat. However, this study revealed that they may also be prescribing these drugs for ischemic and hypertensive heart diseases, a practice not based on evidence derived from clinical trials. Internists and family practitioners prescribed more class I antiarrhythmic drugs than did cardiologists, perhaps because cardiologists are more aware of evidence from clinical trials showing problems with class I antiarrhythmic drugs. On the other hand, general physicians are more likely to see patients without cardiac disease, whose survival has not been shown to be adversely affected by class I antiarrhythmic drugs.

See "Outpatient prescribing of antiarrhythmic drugs from 1995 to 2000," by Dr. Al-Khatib, Nancy M. Allen LaPointe, Pharm.D., Leslie H. Curtis, Ph.D., and others, in the January 1, 2003, American Journal of Cardiology 91, pp. 91-94.

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