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Published on: February 26, 2013
Rhythm Control and Cardiovascular or Cerebrovascular Outcomes in Patients with Atrial Fibrillation: A Study of the
Ho-Gi Chung1, Junbeom Park2, Jin-Kyu Park3
1Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonseiro, Seodaemun-gu, Seoul 03722, Republic of Korea.
Insights
Rhythm control in atrial fibrillation (AF) did not show a significant difference in cardiovascular outcomes compared to rate control in a large registry study. Early rhythm control may still be beneficial for improving patient outcomes.
Area of Science:
- Cardiology
- Clinical Research
- Atrial Fibrillation Management
Background:
- Prognostic significance of rhythm control data in atrial fibrillation (AF) registries remains unclear.
- This study addresses the prognostic value of rhythm control strategies in contemporary AF patient cohorts.
Purpose of the Study:
- To investigate the relationship between rhythm control and cardiovascular outcomes in patients within AF registries.
- To determine if rhythm control offers better cardiovascular outcomes than rate control in AF patients.
Main Methods:
- Utilized data from 6670 patients with AF receiving oral anticoagulation from the CODE-AF registry.
- Employed propensity overlap weighting to balance baseline characteristics between rhythm and rate control groups.
- Assessed a composite primary outcome of cardiovascular death, stroke, acute coronary syndrome, and heart failure, along with secondary outcomes.
Main Results:
- A total of 5407 patients (81.1%) were enrolled within three months of AF diagnosis.
- Over a median follow-up of 973 days, weighted incidence rates for the primary outcome were 1.4 events/100 person-years for rhythm control and 1.5 for rate control.
- No significant difference was observed in the primary outcome (weighted HR: 0.87; 95% CI: 0.66-1.17) or secondary outcomes between the two groups.
Conclusions:
- In a prospective AF registry, rhythm control did not differ from rate control regarding cardiovascular or cerebrovascular outcomes when initiated later after diagnosis.
- Findings suggest that early rhythm control strategies should be considered to potentially improve outcomes in AF patients.
- The study highlights the need for further research into optimal timing for rhythm control interventions in AF.
Background:
It is not clear whether the data regarding rhythm control during atrial fibrillation (AF) contained in AF registries is prognostically significant. Thus, this study investigated the relationship between rhythm control and cardiovascular outcomes in patients in contemporary AF registries.
Methods:
This study was conducted using data from 6670 patients with AF receiving oral anticoagulation in the CODE-AF registry. We used propensity overlap weighting to account for differences in baseline characteristics between the rhythm control and rate control groups. The primary outcome was a composite of the rate of death due to cardiovascular causes, stroke, acute coronary syndrome, and heart failure. The secondary outcomes were individual components of the primary outcome.
Results:
In the CODE-AF registry, 5407 (81.1%) patients were enrolled three months after AF diagnosis. During a median follow-up period of 973 days (interquartile range: 755-1089 days), a primary outcome event occurred in 72 patients in the rhythm control group (1.4 events per 100 person-years) and in 211 patients in the rate control group (1.8 events per 100 person-years). However, after overlap weighting, the incidence rates were 1.4 and 1.5 events per 100 person-years, respectively. No significant difference was found in either the primary outcome (weighted HR: 0.87; 95% CI: 0.66-1.17; p = 0.363) or secondary outcomes between the rhythm control and rate control groups.
Conclusion:
In a prospective AF registry in which most of the population was enrolled at least three months after AF diagnosis, no difference in the risk of cardiovascular or cerebrovascular outcomes was found between the rhythm control and rate control groups, suggesting the early rhythm control should be considered to improve the outcome of patients.
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