Author's Accepted Manuscript
Amiodarone and risk of acute pancreatitis Hsiu-Nien Shen
PII: DOI: Reference:
S1547-5271(15)00334-3 http://dx.doi.org/10.1016/j.hrthm.2015.03.035 HRTHM6188
To appear in:
Heart Rhythm
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Cite this article as: Hsiu-Nien Shen, Amiodarone and risk of acute pancreatitis, Heart Rhythm, http://dx.doi.org/10.1016/j.hrthm.2015.03.035 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Title: Amiodarone and risk of acute pancreatitis Hsiu-Nien Shen Affiliations: From the Department of Intensive Care Medicine, Chi Mei Medical Center, and Department of Public Health, College of Medicine, National Cheng Kung University. Correspondence to: Hsiu-Nien Shen, MD, Department of Intensive Care Medicine, Chi Mei Medical Center, No. 901 Chung-Hwa Rd, Yong-Kang District, Tainan, Taiwan. Tel: +886-6-2812811 ext 57106 E-mail address: [email protected] Key words: Amiodarone; acute pancreatitis; atrial fibrillation. To the Editor:
I read with interest a recent article on amiodarone use and risk of acute pancreatitis (AP) by Lai et al.1 In this case-control study, they found that persons with current use of amiodarone (prescribed within 3 months) were associated with an increased odds of AP (adjusted odds ratio 5.21 [OR], 95% confidence interval [CI] 3.22-8.43).1 This finding is of clinical importance; however, the observed association may be partly explained by misclassification bias and residual confounding that were not addressed in the article. The accuracy of International Classification of Diseases code 577.0 for AP is only moderate.2,3 Because the code performed better in excluding than in including the diagnosis,2 a differential misclassification is likely present and may overestimate the odds.1
Amiodarone is mainly prescribed for patients with atrial fibrillation (AF). Therefore, the observed association may be confounded by the association between AF and AP. However, this measurable confounder was not considered in their analysis.1 The significance of the residual confounding may be supported by a similar study by Alonso et al. showing a smaller odds of AP (OR 1.86) in patients with nonvalvular AF using amiodarone within 12 months.4 Finally, the high prevalence of hypertriglyceridemia in AP cases (36.78%) and controls (21.94%) is surprising.1 In another study on digoxin and risk of AP by Lai et al.,5 the prevalence was 2.39% and 0.90% in cases and controls, respectively. The corresponding figures are 3.2% and 1.4% in cases and controls, respectively, in Alonso’s study.4 The prevalence data in the present study1 may be incorrect.
Conflict of interest No conflict of interest to declare.
References 1. Lai SW, Lin CL, Liao KF, Lin CY. Amiodarone use and risk of acute pancreatitis: A population-based case-control study. Heart Rhythm 2015;12:163-166. 2. Yadav D, Dhir R. How accurate are ICD-9 codes for acute (AP) and chronic (CP) pancreatitis? A large VA hospital experience (Abstract). Pancreas 2006;33:508. 3. Shen HN, Lu CL, Li CY. Epidemiology of first-attack acute pancreatitis in Taiwan from 2000 through 2009: a nationwide population-based study. Pancreas 2012;41:696-702. 4. Alonso A, MacLehose RF, Lutsey PL, Konety S, Chen LY. Association of amiodarone use with acute pancreatitis in patients with atrial fibrillation: a nested case-control study. JAMA Intern Med 2015;175:449-450. 5. Lai SW, Lin CL, Liao KF. Digoxin use may increase the relative risk of acute pancreatitis: A population-based case-control study in Taiwan. Int J Cardiol 2014 Nov 27;181C:235-238. doi: 10.1016/j.ijcard.2014.11.217.
Amiodarone and risk of acute pancreatitis Hsiu-Nien Shen
PII: DOI: Reference:
S1547-5271(15)00334-3 http://dx.doi.org/10.1016/j.hrthm.2015.03.035 HRTHM6188
To appear in:
Heart Rhythm
www.elsevier.com/locate/buildenv
Cite this article as: Hsiu-Nien Shen, Amiodarone and risk of acute pancreatitis, Heart Rhythm, http://dx.doi.org/10.1016/j.hrthm.2015.03.035 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Title: Amiodarone and risk of acute pancreatitis Hsiu-Nien Shen Affiliations: From the Department of Intensive Care Medicine, Chi Mei Medical Center, and Department of Public Health, College of Medicine, National Cheng Kung University. Correspondence to: Hsiu-Nien Shen, MD, Department of Intensive Care Medicine, Chi Mei Medical Center, No. 901 Chung-Hwa Rd, Yong-Kang District, Tainan, Taiwan. Tel: +886-6-2812811 ext 57106 E-mail address: [email protected] Key words: Amiodarone; acute pancreatitis; atrial fibrillation. To the Editor:
I read with interest a recent article on amiodarone use and risk of acute pancreatitis (AP) by Lai et al.1 In this case-control study, they found that persons with current use of amiodarone (prescribed within 3 months) were associated with an increased odds of AP (adjusted odds ratio 5.21 [OR], 95% confidence interval [CI] 3.22-8.43).1 This finding is of clinical importance; however, the observed association may be partly explained by misclassification bias and residual confounding that were not addressed in the article. The accuracy of International Classification of Diseases code 577.0 for AP is only moderate.2,3 Because the code performed better in excluding than in including the diagnosis,2 a differential misclassification is likely present and may overestimate the odds.1
Amiodarone is mainly prescribed for patients with atrial fibrillation (AF). Therefore, the observed association may be confounded by the association between AF and AP. However, this measurable confounder was not considered in their analysis.1 The significance of the residual confounding may be supported by a similar study by Alonso et al. showing a smaller odds of AP (OR 1.86) in patients with nonvalvular AF using amiodarone within 12 months.4 Finally, the high prevalence of hypertriglyceridemia in AP cases (36.78%) and controls (21.94%) is surprising.1 In another study on digoxin and risk of AP by Lai et al.,5 the prevalence was 2.39% and 0.90% in cases and controls, respectively. The corresponding figures are 3.2% and 1.4% in cases and controls, respectively, in Alonso’s study.4 The prevalence data in the present study1 may be incorrect.
Conflict of interest No conflict of interest to declare.
References 1. Lai SW, Lin CL, Liao KF, Lin CY. Amiodarone use and risk of acute pancreatitis: A population-based case-control study. Heart Rhythm 2015;12:163-166. 2. Yadav D, Dhir R. How accurate are ICD-9 codes for acute (AP) and chronic (CP) pancreatitis? A large VA hospital experience (Abstract). Pancreas 2006;33:508. 3. Shen HN, Lu CL, Li CY. Epidemiology of first-attack acute pancreatitis in Taiwan from 2000 through 2009: a nationwide population-based study. Pancreas 2012;41:696-702. 4. Alonso A, MacLehose RF, Lutsey PL, Konety S, Chen LY. Association of amiodarone use with acute pancreatitis in patients with atrial fibrillation: a nested case-control study. JAMA Intern Med 2015;175:449-450. 5. Lai SW, Lin CL, Liao KF. Digoxin use may increase the relative risk of acute pancreatitis: A population-based case-control study in Taiwan. Int J Cardiol 2014 Nov 27;181C:235-238. doi: 10.1016/j.ijcard.2014.11.217.
