Amiodarone For Primary Prevention Of Mortality In Congestive Heart Failure: A Meta-analysis Of Randomized Controlled Trials

OBJECTIVES This meta-analysis was designed to evaluate the safety and efficacy of amiodarone in reducing the risk of sudden death and total mortality in CHF patients, in order to provide additional evidence for clinical doctors'decision when using the drug.METHODS We conducted a search in PUBMED and Conchrane Controlled Trials Register (CCRT). Randomized controlled trials reporting the death rate of CHF patients after treatment with amiodarone were obtained. After evaluating the quality of each trial, we extracted useful data for conducting this meta-analysis.RESULTS A total of 8 trials were selected and 3266 patients were randomized to receive amiodarone or placebo/control. As a result of this analysis, amiodarone reduced the risk of sudden death by 22% (OR 0.78 [95%CI 0.64,0.95], P=0.02) and cardiovascular death by 17% (OR 0.83 [95%CI 0.71,0.98], P=0.03). There was a 12% reduction in OR of total mortality which did not meet statistical significance (P=0.08). However, amiodarone reduced the risk of total mortality in ischemic subgroup and NYHAⅠ/Ⅱsubgroup by 23% (OR 0.77[95%CI 0.59,0.99], P=0.04) and 25% (OR 0.75[95%CI 0.59,0.96], P=0.02) respectively.CONCLUSIONS Comparing with placebo/control, amiodarone significantly decrease the risk of sudden death in CHF patients by 22% and cardiovascular death by 17%. Accordingly, amiodarone is an effective alternative drug for the CHF patients who are unsuitable for or unable to afford ICD therapy. As to total motality, the effect of amiodarone in CHF patients was neutral, but it can improve the survival rate in CHF patients with ischemic etiology and those in NYHA classⅠ/Ⅱ.