From the Guidelines
Multaq (dronedarone) is contraindicated in patients with congestive heart failure (CHF) due to its potential to increase mortality in these patients. This recommendation is based on the most recent and highest quality evidence available, including the ANDROMEDA trial 1, which was terminated early due to increased mortality in heart failure patients taking dronedarone. The medication can worsen heart failure by decreasing cardiac contractility and increasing mortality in these vulnerable patients.
The ANDROMEDA trial, as well as other studies such as the PALLAS trial 1, have demonstrated that dronedarone can increase the risk of cardiovascular events, including mortality, in patients with heart failure. The European Society of Cardiology guidelines also recommend that dronedarone should not be used in patients with symptomatic heart failure or NYHA Class IV heart failure, or patients with a recent decompensation requiring hospitalization or referral to a specialized heart failure clinic 1.
Key points to consider when evaluating the use of Multaq in patients with CHF include:
- The potential for increased mortality and cardiovascular events
- The negative inotropic effects of the medication, which can worsen heart failure
- The availability of alternative antiarrhythmic medications, such as amiodarone, or other management strategies like rate control, under careful cardiologist supervision.
Overall, the evidence suggests that Multaq should be avoided in patients with CHF due to its potential to increase mortality and worsen heart failure.
From the FDA Drug Label
MULTAQ is contraindicated in patients with symptomatic heart failure with recent decompensation requiring hospitalization or NYHA Class IV heart failure. MULTAQ doubles the risk of death in these patients (4,5.1,14. 3). In patients with symptomatic heart failure and recent decompensation requiring hospitalization or NYHA Class IV heart failure; MULTAQ doubles the risk of death.
Multaq is contraindicated in CHF with recent decompensation requiring hospitalization or NYHA Class IV symptoms 2, 2.
- Key points:
- Multaq doubles the risk of death in patients with symptomatic heart failure and recent decompensation requiring hospitalization or NYHA Class IV heart failure.
- Contraindicated in patients with symptomatic heart failure with recent decompensation requiring hospitalization or NYHA Class IV heart failure.
From the Research
Multaq Contraindication in CHF
- Multaq, also known as dronedarone, is contraindicated in severe or deteriorating heart failure, as shown in the ANDROMEDA trial 3.
- The ANDROMEDA trial demonstrated that dronedarone is contraindicated in patients with severe or unstable congestive heart failure, highlighting the importance of careful patient selection when prescribing this medication.
- In contrast, the ATHENA trial showed that dronedarone significantly reduced the incidence of hospitalization due to cardiovascular events or death in high-risk patients with atrial fibrillation, but this benefit was not seen in patients with severe heart failure 3, 4.
- A post-hoc analysis of the ATHENA trial found that dronedarone was associated with reduced cardiovascular events in patients with paroxysmal or persistent AF/AFL and heart failure across the spectrum of left ventricular ejection fraction, including those with heart failure with preserved and mildly reduced ejection fraction 5.
- However, the use of dronedarone in patients with heart failure with reduced ejection fraction is still a topic of debate, and more research is needed to fully understand its effects in this population.
- Other studies have focused on the use of ACE inhibitors, angiotensin-2 receptor blockers, and beta-blockers in heart failure, but these do not directly address the contraindication of Multaq in CHF 6, 7.