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Published on: February 26, 2013
Eligibility for early rhythm control in patients with atrial fibrillation in the UK Biobank
Shinwan Kany1,2,3, Victor Roth Cardoso4,5,6,7, Laura Bravo5,6,7
1Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Insights
Early rhythm-control therapy for atrial fibrillation (AF) is safe and benefits patients recently diagnosed with AF. Most UK patients with AF are eligible for this early intervention, improving cardiovascular outcomes.
Area of Science:
- Cardiology
- Clinical Trials
- Public Health
Background:
- The Early Treatment of Atrial Fibrillation for Stroke Prevention (EAST-AFNET4) trial demonstrated the benefits of early rhythm-control therapy for recent-onset atrial fibrillation (AF).
- The generalizability of these findings to the broader population remained uncertain.
Purpose of the Study:
- To assess the real-world generalizability of the EAST-AFNET4 trial findings in a large, population-based cohort.
- To evaluate the effectiveness and safety of early rhythm-control therapy versus usual care for patients with atrial fibrillation in routine practice.
Main Methods:
- UK Biobank participants were assessed for eligibility based on EAST-AFNET4 criteria.
- Treatment was classified as early rhythm-control (antiarrhythmic drugs or ablation) or usual care.
- Primary care data and Hospital Episode Statistics were merged with UK Biobank data for outcome assessment, including propensity-matched analysis.
Main Results:
- 80.9% of incident atrial fibrillation (AF) cases were eligible for early rhythm-control therapy.
- Early rhythm-control was associated with a reduced risk of the primary composite outcome (cardiovascular death, stroke, heart failure, or acute coronary syndrome) in the entire cohort (HR 0.82; P=0.005).
- In the propensity-score matched analysis, the benefit of early rhythm-control was not statistically significant (HR 0.87; P=0.124), though safety outcomes were similar between groups.
Conclusions:
- A significant majority of individuals diagnosed with AF in the UK population meet eligibility criteria for early rhythm-control therapy.
- Early rhythm-control therapy is safe when implemented in routine clinical care.
- The study supports the potential for widespread application of early rhythm-control strategies in managing atrial fibrillation.
Objective:
The Early Treatment of Atrial Fibrillation for Stroke Prevention (EAST-AFNET4) trial showed a clinical benefit of early rhythm-control therapy in patients with recently diagnosed atrial fibrillation (AF). The generalisability of the results in the general population is not known.
Methods:
Participants in the population-based UK Biobank were assessed for eligibility based on the EAST-AFNET4 inclusion/exclusion criteria. Treatment of all eligible participants was classified as early rhythm-control (antiarrhythmic drug therapy or AF ablation) or usual care. To assess treatment effects, primary care data and Hospital Episode Statistics were merged with UK Biobank data.Efficacy and safety outcomes were compared between groups in the entire cohort and in a propensity-matched data set.
Results:
AF was present in 35 526/502 493 (7.1%) participants, including 8340 (988 with AF <1 year) with AF at enrolment and 27 186 with incident AF during follow-up. Most participants (22 003/27 186; 80.9%) with incident AF were eligible for early rhythm-control.Eligible participants were older (70 years vs 63 years) and more likely to be female (42% vs 21%) compared with ineligible patients. Of 9004 participants with full primary care data, 874 (9.02%) received early rhythm-control. Safety outcomes were not different between patients receiving early rhythm-control and controls. The primary outcome of EAST-AFNET 4, a composite of cardiovascular death, stroke/transient ischaemic attack and hospitalisation for heart failure or acute coronary syndrome occurred less often in participants receiving early rhythm-control compared with controls in the entire cohort (HR 0.82, 95% CI 0.71 to 0.94, p=0.005). In the propensity-score matched analysis, early rhythm-control did not significantly decrease of the primary outcome compared with usual care (HR 0.87, 95% CI 0.72 to 1.04, p=0.124).
Conclusion:
Around 80% of participants diagnosed with AF in the UK population are eligible for early rhythm-control. Early rhythm-control therapy was safe in routine care.
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