Dofetilide use is not associated with increased mortality in patients with left ventricular hypertrophy and atrial fibrillation.

BACKGROUND: Left ventricular hypertrophy (LVH) is common in patients with atrial fibrillation (AF), however, many antiarrhythmic drugs (AADs) are contraindicated. US guidelines recommend avoiding pure class III antiarrhythmics such as dofetilide in patients with significant LVH due to concern for an increased risk of death, however, clinical data is lacking. We sought to determine if dofetilide use was associated with increased mortality in patients with LVH. METHODS: Patients ≥18 years of age with AF and LVH ≥ 1.4 cm were included. A group of patients treated with dofetilide and a control group of patients without a history of AAD use were propensity matched. The primary outcome was all-cause mortality at 3 years and secondary outcomes were total number of all-cause hospitalizations and hospitalizations related to AF. RESULTS: There were 359 patients in each of the groups. Baseline variables were well-matched. The primary outcome of all-cause mortality occurred in 7% of patients in the dofetilide group and 12% of patients in the control group (hazard ratio: 0.90, 95% confidence interval: 0.53-1.53). Total all-cause hospitalizations were higher in the control group but hospitalizations for AF were no different. CONCLUSIONS: In a propensity-matched cohort of 718 patients with AF and LVH, dofetilide was not associated with increased mortality at 3 years. Our study adds to prior data demonstrating the safety of dofetilide in this population despite guideline recommendations against its use. Given the limited options for AF management in LVH patients, dofetilide may be reasonable for symptomatic AF management.

Does education modify the association between depression and cardiovascular health? (from the National Health and Nutritional Examination Survey, 2013-14 and 2015-16).

Study objective: Depression and education have associations with cardiovascular health. We hypothesized educational attainment would modify the association between depression and cardiovascular health. Design: We used the Patient Health Questionnaire (PHQ), a validated instrument to categorize individuals as having minimal (0-4), moderate (5-9) or severe (≥10) depression. We employed the American Heart Association's Life's Simple 7 (LS7) comprised of known cardiovascular risk factors. In multivariable-adjusted analyses we related PHQ to cardiovascular health measured by LS7. We then evaluated the modification of the association between depression and cardiovascular health by educational attainment. Participants: Individuals age ≥18 years participating in the National Health and Nutrition Examination Survey 2013-214 and 2015-16 cycles. Main outcome measures: LS7, continuous (0-14) and categorized as poor (0-4), intermediate (5-9) or ideal (10-14). Results: In total 8727 individuals (age 48 ± 17 years; 51% female sex; 70% white race; 14% < high school graduate; 32% ≥ college graduate) were included. Among those with mild depression, educational attainment greater than a high school degree or equivalent was significantly more likely to have higher LS7 scores than those without high school graduation. In participants with moderate depression, only those with college education or greater were more likely to have higher LS7 scores (odds ratio [OR] 3.49, 95% confidence interval [CI] 2.01-6.08). In those with severe depression, educational attainment did not modify LS7 scores. Conclusions: Our findings suggest that educational attainment modifies the association between depression and cardiovascular health. This study provides insight on how social factors modify depression, a well-recognized contributor to cardiovascular health.