Functional status with rhythm- versus rate-control strategy for persistent atrial fibrillation

Area of Science:

• Cardiology
• Internal Medicine

Background:

• Recent studies suggest rhythm control offers no mortality or morbidity benefits over rate control for atrial fibrillation (AF) and is less cost-effective.
• The impact of rate versus rhythm control on quality of life (QoL) and functional capacity in AF patients remains under investigation.

Purpose of the Study:

• To compare the functional status and QoL of patients with persistent AF randomized to either rate or rhythm control strategies.
• To assess the effectiveness of rhythm control versus rate control in improving New York Heart Association (NYHA) functional classification and exercise tolerance.

Main Methods:

• A substudy of the HOT CAFE trial enrolled 205 patients with persistent AF, randomly assigned to rate or rhythm control.
• Evaluated NYHA functional classification, symptom intensity, exercise tolerance (treadmill test), and QoL over a mean follow-up of 1.7 years.

Main Results:

• Both rate and rhythm control strategies improved NYHA class, QoL, and exercise tolerance in AF patients.
• Rhythm control demonstrated superiority in improving NYHA class for patients with AF and hypertension (OR 1.89) and moderate heart failure (OR 2.04).
• Rhythm control was also superior in improving left ventricular function in hypertensive patients (OR 2.64) and those with NYHA class II/III (OR 4.27).

Conclusions:

• Both rate and rhythm control strategies enhance functional status in persistent AF.
• Rhythm control may be a more appropriate strategy for patients with coexisting AF and hypertension or moderate heart failure.
• Further research is needed to fully elucidate QoL benefits in specific AF patient subgroups.