Proton Pump Inhibitors and Atrial Fibrillation
Abstract
Background Proton pump inhibitors (PPIs) are widely used drugs in the United States. Atrial fibrillation (AF) affects 2.7 million people in this country and often leads to other serious medical conditions. There is a growing body of evidence suggesting that PPIs may be proarrhythmic. This study seeks to better appreciate the relationship between these popular drugs and the most common arrhythmia. Methods This is a nested case-control study using a large, nationally representative insurance database. Members with an incident AF diagnosis between 2007 and 2009 were identified. Each case was matched with one control member, using incidence density sampling, and both were assigned an index date of the case’s date of AF diagnosis. PPI exposure was assessed through pharmacy claim records for both cases and controls prior to their assigned index date. Multivariable analysis was accomplished through conditional logistic regression as a means of comparing PPI exposure among cases and controls. Results The study included 40,484 eligible members (20,265 cases and 20,219 controls). Bivariate analyses revealed that cases were more likely to have each of the potentially confounding comorbidities of interest than controls. An unadjusted multivariable analysis suggested that cases were more likely to have redeemed a PPI prescription OR= 3.53 PPIs and AF 4 [3.12 – 3.99]. Following adjustment, the association diminished but remained significant OR= 1.98 [1.63 – 2.41]. A sensitivity analysis…
How strong is the evidence?
Evidence Hub reads this as a case-control. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause. Reported size: 7 participants or records.
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