Publications of the Week, February 3


Alcohol abstinence in regular drinkers with atrial fibrillation

Voskoboinik A, Kalman JM, De Silva A, et al. Alcohol Abstinence in Drinkers with Atrial Fibrillation. N Engl J Med. 2020 Jan 2;382(1):20-28. doi: 10.1056/NEJMoa1817591. PubMed PMID: 31893513.
Gillis AM. A Sober Reality? Alcohol, Abstinence, and Atrial Fibrillation. N Engl J Med. 2020 Jan 2;382(1):83-84. doi: 10.1056/NEJMe1914981. PubMed PMID: 31893520.

Alcohol consumption increases the risk of atrial fibrillation (AF) recurrence.

This Australian study included 140 adults with a history of paroxysmal or persistent AF, controlled by medical therapy, who consumed >10 standard drinks of alcohol per week (~12 g of pure alcohol per drink) and were in sinus rhythm at the time of study entry. Their mean age was ~62 years and 85% were males. Study participants were assigned to an abstinence group, with advice to completely abstain from alcohol intake, or to a control group. The recurrence of AF, defined as any atrial tachyarrhythmia lasting >30 seconds, was investigated with the help of numerous strategies including loop recordings, Holter monitoring, and mobile phone apps.

Patients in the abstinence group reduced their alcohol intake by >80% (from ~17 to 2 standard drinks per week), with complete abstinence achieved in 61% of the group. Control group patients reduced their consumption by ~20% (from 16 to 13 drinks per week, on average).

After 6 months, AF was recorded for >30 seconds in 53% of patients in the abstinence group and in 73% in the control group (hazard ratio [HR], 0.55; 95% CI, 0.36-0.84). Compared with controls, patients in the abstinence group reduced their weight on average by 3.7 kg.

The authors conclude that moderate-to-high alcohol intake is a modifiable risk factor for recurrence of AF, but at the same time they caution about overinterpretation of the study results, pointing to the low number of patients studied, underrepresentation of women, and unclear clinical interpretation of short periods of AF.

Oseltamivir in primary care for patients with influenza-like illness

Butler CC, van der Velden AW, Bongard E, et al. Oseltamivir plus usual care versus usual care for influenza-like illness in primary care: an open-label, pragmatic, randomised controlled trial. Lancet. 2020 Jan 4;395(10217):42-52. doi: 10.1016/S0140-6736(19)32982-4. Epub 2019 Dec 12. PubMed PMID: 31839279.

Adding oseltamivir to usual care shortens the duration of symptoms among primary-care patients presenting with influenza-like illness.

In this randomized study 3266 patients received either usual care or usual care plus oral oseltamivir (75 mg twice a day for 5 days; dose adjusted in children). Of all patients, 52% had laboratory-confirmed influenza infection. The primary outcome was time to return to usual daily activity, with fever, headache, and muscle ache rated as minor or no problem.

The average duration of symptoms among patients in the usual care group was 6.73 days. The estimated mean benefit of oseltamivir in shortening the duration of symptoms was ~1 day in total population and was highest (3.2-day shortening) in the subgroup of patients ≥65 years of age who had more severe and longer illness (>48 hours before starting treatment vs shorter time) and more comorbidities. The effect did not differ in those with laboratory-confirmed influenza infection and those who did not test positively. Vomiting and nausea were associated with oseltamivir use (21% vs 16%).

The authors conclude that oseltamivir shortens the duration of influenza-like illness, especially in the setting of more severe and longer disease, irrespective of influenza laboratory testing and time of starting treatment.

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