Dronedarone should be avoided in older adults with which conditions?

• A. Hypertension
• B. Pulmonary disease
• C. Atrial fibrillation with well-controlled HF
• D. Permanent AF or severe or recently decompensated heart failure

Answer: (D)

Dronedarone is avoided in older adults when there is permanent atrial fibrillation or severe or recently decompensated heart failure because safety data show a higher risk of harm in these situations without a clear, meaningful benefit. In permanent AF, the rhythm-control advantage of dronedarone is unlikely to be realized, so exposing patients to potential adverse effects isn’t justified. In those with severe or recently decompensated heart failure, dronedarone can worsen heart function and has been linked to increased mortality and hospitalizations. Because older adults often have limited cardiac reserve and multiple comorbidities, the Beers Criteria flags this combination as potentially inappropriate. In other scenarios, like hypertension or pulmonary disease without decompensation, the concern is less pronounced, though individual risk and drug interactions should still be considered.