TY - JOUR

T1 - Fluoroquinolones do not provide added risk of out-of-hospital cardiac arrest

T2 - A nationwide study

AU - Ellenardóttir, Viktoría

AU - Coronel, Ruben

AU - Folke, Fredrik

AU - Halili, Andrim

AU - Arulmurugananthavadivel, Anojhaan

AU - Parveen, Saaima

AU - Andersen, Mikkel Porsborg

AU - Schou, Morten

AU - Torp-Pedersen, Christian

AU - Gislason, Gunnar

AU - Eroglu, Talip E.

N1 - Publisher Copyright: © 2024 BMJ Publishing Group. All rights reserved.

PY - 2024

Y1 - 2024

N2 - Aim Conflicting results have been reported regarding the association between fluoroquinolones (FQs) and the risk of out-of-hospital cardiac arrest (OHCA). In particular, it has not become clear whether OHCA in FQ users is related to the inherent comorbidities or whether there is a direct pro-arrhythmic effect of FQs. Therefore, we studied the relation between FQs and OHCA in the general population. Methods Through Danish nationwide registries, we conducted a nested case-control study with OHCA cases of presumed cardiac causes and age/sex/OHCA date-matched non-OHCA controls from the general population. Conditional logistic regression models with adjustments for well-known risk factors of OHCA were employed to estimate the OR with 95% CI of OHCA comparing FQs with amoxicillin. Results The study population consisted of 46 578 OHCA cases (mean: 71 years (SD: 14.40), 68.8% men) and 232 890 matched controls. FQ was used by 276 cases and 328 controls and conferred no increase in the odds of OHCA compared with amoxicillin use after controlling for the relevant confounders (OR: 0.91 (95% CI: 0.71 to 1.16)). The OR of OHCA associated with FQ use did not vary significantly by age (OR ≤65: 0.96 (95% CI: 0.53 to 1.74), OR >65: 0.88 (95% CI: 0.67 to 1.16), p value interaction=0.7818), sex (OR men: 0.96 (95% CI: 0.70 to 1.31), OR women: 0.80 (95% CI: 0.53 to 1.20), p value interaction=0.9698) and pre-existing cardiovascular disease (OR absent: 1.02 (95% CI: 0.57 to 1.82), OR present: 0.98 (95% CI: 0.75 to 1.28), p value interaction=0.3884), including heart failure (OR absent: 0.93 (95% CI: 0.72 to 1.22), OR present: 1.11 (95% CI: 0.61 to 2.02), p value interaction=0.7083) and ischaemic heart disease (OR absent: 0.85 (95% CI: 0.64 to 1.12), OR present: 1.38 (95% CI: 0.86 to 2.21), p value interaction=0.6230). Conclusion Our findings do not support an association between FQ exposure and OHCA in the general population. This lack of association was consistent in men and women, in all age categories, and in the presence or absence of cardiovascular disease.

AB - Aim Conflicting results have been reported regarding the association between fluoroquinolones (FQs) and the risk of out-of-hospital cardiac arrest (OHCA). In particular, it has not become clear whether OHCA in FQ users is related to the inherent comorbidities or whether there is a direct pro-arrhythmic effect of FQs. Therefore, we studied the relation between FQs and OHCA in the general population. Methods Through Danish nationwide registries, we conducted a nested case-control study with OHCA cases of presumed cardiac causes and age/sex/OHCA date-matched non-OHCA controls from the general population. Conditional logistic regression models with adjustments for well-known risk factors of OHCA were employed to estimate the OR with 95% CI of OHCA comparing FQs with amoxicillin. Results The study population consisted of 46 578 OHCA cases (mean: 71 years (SD: 14.40), 68.8% men) and 232 890 matched controls. FQ was used by 276 cases and 328 controls and conferred no increase in the odds of OHCA compared with amoxicillin use after controlling for the relevant confounders (OR: 0.91 (95% CI: 0.71 to 1.16)). The OR of OHCA associated with FQ use did not vary significantly by age (OR ≤65: 0.96 (95% CI: 0.53 to 1.74), OR >65: 0.88 (95% CI: 0.67 to 1.16), p value interaction=0.7818), sex (OR men: 0.96 (95% CI: 0.70 to 1.31), OR women: 0.80 (95% CI: 0.53 to 1.20), p value interaction=0.9698) and pre-existing cardiovascular disease (OR absent: 1.02 (95% CI: 0.57 to 1.82), OR present: 0.98 (95% CI: 0.75 to 1.28), p value interaction=0.3884), including heart failure (OR absent: 0.93 (95% CI: 0.72 to 1.22), OR present: 1.11 (95% CI: 0.61 to 2.02), p value interaction=0.7083) and ischaemic heart disease (OR absent: 0.85 (95% CI: 0.64 to 1.12), OR present: 1.38 (95% CI: 0.86 to 2.21), p value interaction=0.6230). Conclusion Our findings do not support an association between FQ exposure and OHCA in the general population. This lack of association was consistent in men and women, in all age categories, and in the presence or absence of cardiovascular disease.

KW - Death, Sudden, Cardiac

KW - Epidemiology

KW - Pharmacology

U2 - 10.1136/openhrt-2023-002520

DO - 10.1136/openhrt-2023-002520

M3 - Journal article

C2 - 38216172

AN - SCOPUS:85183027686

VL - 11

JO - Open Heart

JF - Open Heart

SN - 2398-595X

IS - 1

M1 - e002520

ER -