Which antiarrhythmic should be avoided in older adults with heart failure due to potential mortality?

• A. Cilostazol
• B. Dextromethorphan-Quinidine
• C. Dronedarone
• D. NSAIDs and COX-2 inhibitors

Answer: (C)

Avoid dronedarone in older adults with heart failure because it has been shown to increase mortality in patients with symptomatic or decompensated heart failure. The pivotal trial experience demonstrated higher death rates and more heart failure hospitalizations among those taking dronedarone, which led guidelines and the Beers Criteria to label its use as contraindicated in decompensated or advanced HF (and to exercise caution in heart failure patients overall). The potential benefit of rhythm control does not outweigh this clear mortality risk in this population, which is why dronedarone is avoided. The other options listed are not antiarrhythmics with the same HF mortality signal, or are used for other indications, so they don’t carry the same risk in this scenario.