Generalizability of the EAST‐AFNET 4 Trial: Assessing Outcomes of Early Rhythm‐Control Therapy in Patients With Atrial Fibrillation

Figure 1. Patient selection flow chart. From July 28, 2011, to December 30, 2016, the enrollment period of EAST‐AFNET 4 (Early Treatment of Atrial Fibrillation for Stroke Prevention Trial), we identified 109 739 patients with newly diagnosed atrial fibrillation (AF) (overall cohort). The majority of patients (72.9%; 79 948 of 109 739) would have been eligible for EAST‐AFNET 4. AAD indicates antiarrhythmic drug.

Figure 2. Primary composite end point and cumulative incidence of stroke stratified by EAST‐AFNET 4 (Early treatment of atrial fibrillation for stroke prevention trial) eligibility criteria. Cumulative incidence curves for the primary outcome, a composite of all‐cause mortality, stroke, or hospitalization with the diagnoses of heart failure or myocardial infarction in the early rhythm‐control group (red) or control group (blue), stratified by EAST‐AFNET 4 trial eligibility criteria. Overall cohort (A and B), patients who would be potentially eligible for EAST‐AFNET 4 (C and D), and patients who would be ineligible for EAST‐AFNET 4 (E and F). The control group was the reference group in the Cox proportional hazards regression analyses. All of the curves and numbers were calculated using propensity score weighting. *To maintain deidentification, OptumLabs does not allow researchers to disclose the number of events when the number is ≤10. HR indicates hazard ratio.

Figure 3. Subgroup analysis for the primary outcome in propensity score–weighted patients. Hazard ratios and P values for interaction are based on Cox proportional hazards regression analyses on the composite end point of all‐cause mortality, stroke, or hospitalization with the diagnoses of heart failure or myocardial infarction. There were significant interactions between early rhythm control and age, as well as cardiomyopathy, which imply that the reduction in the composite end point associated with early rhythm control was greater in patients aged <75 years and patients without cardiomyopathy.