In patients with atrial fibrillation, rate-control treatment with β-blockers (HR 0.76; 95% CI 0.74-0.78) or calcium channel blockers reduced mortality risk compared to no rate-control medication.
Cohort (n=269,921)
Do rate-control drugs (β-blockers, calcium channel blockers, or digoxin) reduce all-cause mortality in patients with atrial fibrillation compared to no rate-control treatment?
In a nationwide cohort of patients with atrial fibrillation, rate control with beta-blockers or calcium channel blockers was associated with lower mortality, whereas digoxin was associated with higher mortality.
Hazard Ratio: 0.76 (95% CI 0.74–0.78)
BACKGROUND: Current American and European guidelines emphasize the importance of rate-control treatments in treating atrial fibrillation with a Class I recommendation, although data on the survival benefits of rate control are lacking. The goal of the present study was to investigate whether patients receiving rate-control drugs had a better prognosis compared with those without rate-control treatment. METHODS AND RESULTS: This study used the National Health Insurance Research Database in Taiwan. There were 43 879, 18 466, and 38 898 patients with atrial fibrillation enrolled in the groups receiving β-blockers, calcium channel blockers, and digoxin, respectively. The reference group consisted of 168 678 subjects who did not receive any rate-control drug. The clinical end point was all-cause mortality. During a follow-up of 4.9±3.7 years, mortality occurred in 88 263 patients (32.7%). After adjustment for baseline differences, the risk of mortality was lower in patients receiving β-blockers (adjusted hazard ratio=0.76; 95% confidence interval=0.74-0.78) and calcium channel blockers (adjusted hazard ratio=0.93; 95% confidence interval=0.90-0.96) compared with those who did not receive rate-control medications. On the contrary, the digoxin group had a higher risk of mortality with an adjusted hazard ratio of 1.12 (95% confidence interval=1.10-1.14). The results were observed consistently in subgroup analyses and among the cohorts after propensity matching. CONCLUSIONS: In this nationwide atrial fibrillation cohort, the risk of mortality was lower for patients receiving rate-control treatment with β-blockers or calcium channel blockers, and the use of β-blockers was associated with the largest risk reduction. Digoxin use was associated with greater mortality. Prospective, randomized trials are necessary to confirm these findings.
Chao et al. (Fri,) conducted a cohort in Atrial fibrillation (n=269,921). Rate-control treatment (β-blockers, calcium channel blockers, or digoxin) vs. No rate-control drug was evaluated on All-cause mortality (HR 0.76, 95% CI 0.74-0.78). In patients with atrial fibrillation, rate-control treatment with β-blockers (HR 0.76; 95% CI 0.74-0.78) or calcium channel blockers reduced mortality risk compared to no rate-control medication.