Fluoroquinolones do not provide added risk of out-of-hospital cardiac arrest: A nationwide study

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.