Prescribing Advice for GPs

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AF not prevented by valsartan

The New England Journal of Medicine has published the results of a randomised controlled trial that aimed to assess whether valsartan could reduce the recurrence of atrial fibrillation (AF).

Some clinical studies have suggested that treatment with angiotensin receptor blockers like valsartan (Diovan®) may prevent AF. This study recruited 1,442 patients in sinus rhythm who had two or more episodes of AF in the previous 6 months or who had been successfully undergone cardioversion in the previous 2 weeks. Participants also had existing morbidities of cardiovascular disease, diabetes or left atrial enlargement.

Participants were randomly assigned to treatment with placebo or valsartan and followed up for 1 year. Data were collected based on time to first recurrence of AF and proportion of patients in whom AF recurred within follow up.

AF recurred in 51.4% of the active treatment arm and in 52.1% of the placebo arm. This difference was not statistically significant (p=0.73) and there was also no difference in the time to recurrence. The authors conclude that, "valsartan was not associated with a reduction in the incidence of recurrent atrial fibrillation".

Action: Clinicians should ensure that treatment choices in AF are based on current evidence; valsartan should not be used to prevent recurrence of AF.

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