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In this hypothetical cohort,fewer patients had disabling events with amiodarone(1.4%)than with quinidine(1.8%),warfarin(2.6%),or no treatment (7.4%).Amiodarone appeared to be associated with the lowest 5-year mortality(13.6%)when compared with warfarin(14.4%),quinidine(15.2%),and no treatment(18.2%).In terms of quality-adjusted life-years,amiodarone had the highest expected value(4.75 years),followed by warfarin(4.72 years), quinidine(4.68 years),and no treatment(4.55 years).Amiodarone remained the preferred strategy using the most plausible scenarios of risks associated with atrial fibrillation.Choices among warfarin,quinidine,and no treatment depended on estimates of bleeding rates with warfarin,stroke rates after discontinuing warfarin,quinidine-related mortality,and the quality of life with warfarin.Cardioversion followed by low-dose amiodarone to maintain normal sinus rhythm appears to be a relatively safe and effective treatment for patients with chronic atrial fibrillation. |
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