Rhythm control initiated <6 months reduced cardiovascular events in both sexes (men HR 0.86, women HR 0.85), but initiation >6 months benefited men (HR 0.72) but not women (HR 1.32).
Cohort
Does rhythm control reduce the composite of cardiovascular death, ischemic stroke, heart failure hospitalization, or acute myocardial infarction in patients with atrial fibrillation compared to rate control, and does this effect differ by sex?
Early rhythm control (within 6 months of diagnosis) is associated with improved cardiovascular outcomes in both men and women with atrial fibrillation, but delayed rhythm control may lack benefit or be harmful in women.
Effect estimate: HR 0.86 (men, <6 months); HR 0.85 (women, <6 months) (95% CI 0.79-0.94 (men, <6 months); 0.78-0.93 (women, <6 months))
p-value: p=0.844 (P for interaction)
Background: This study aimed to investigate the associations between sex and the relative effect of rhythm control over rate control in patients with atrial fibrillation. Methods: We used the National Health Insurance Service database to select patients treated for atrial fibrillation within one year after diagnosis. The primary composite outcome comprised cardiovascular death, ischemic stroke, heart failure hospitalization, or acute myocardial infarction. Results: During the mean follow-up (4.9 ± 3.2 years), the benefit of rhythm control over rate control on the primary composite outcome became statistically insignificant after 3 months from atrial fibrillation diagnosis in women while remained steadily until 12 months in men. The risk of primary composite outcome for rhythm control was lower than that for rate control in both sexes if it was initiated within 6 months (men: HR = 0.86, 95%CI = 0.79–0.94; women: HR = 0.85, 95%CI = 0.78–0.93; P for interaction = 0.844). However, there was significant interaction between sex and the relative effect of rhythm control if it was initiated after 6 months (men: HR = 0.72, 95%CI = 0.52–0.99; women: HR = 1.32, 95%CI = 0.92–1.88; P for interaction = 0.018). Conclusion: Rhythm control resulted in lower risk of primary composite outcome than rate control in both sexes; however, the treatment initiation at an earlier stage might be considered in women.
Kang et al. (Thu,) conducted a cohort in Atrial fibrillation. Rhythm control vs. Rate control was evaluated on Cardiovascular death, ischemic stroke, heart failure hospitalization, or acute myocardial infarction (HR 0.86 (men, <6 months); HR 0.85 (women, <6 months), 95% CI 0.79-0.94 (men, <6 months); 0.78-0.93 (women, <6 months), p=0.844 (P for interaction)). Rhythm control initiated <6 months reduced cardiovascular events in both sexes (men HR 0.86, women HR 0.85), but initiation >6 months benefited men (HR 0.72) but not women (HR 1.32).
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