Key result
A rate-control strategy significantly reduced the risk of the combined endpoint of all-cause death and thromboembolic stroke compared with a rhythm-control approach (OR 0.84; 95% CI 0.73-0.98; P=0.02).
Why the study?
Does a rate-control strategy reduce the combined endpoint of all cause death and thromboembolic stroke compared to a rhythm-control strategy in patients with atrial fibrillation?
Meta-Analysis (n=5,239)
Does a rate-control strategy reduce the combined endpoint of all cause death and thromboembolic stroke compared to a rhythm-control strategy in patients with atrial fibrillation?
Effect estimate: OR 0.84 (95% CI 0.73, 0.98)
p-value: p=0.02
In patients with atrial fibrillation, an initial rate-control strategy is associated with a significantly reduced risk of death and thromboembolic stroke compared to a rhythm-control strategy.
Supports initial rate control over rhythm control in AF to lower death and stroke risk; confirms and extends RCT evidence via meta-analysis.
AIMS: To systematically assess the risk/benefit ratio of a rate-control strategy vs. a rhythm-control strategy in patients with first or recurrent atrial fibrillation (AF). METHODS AND RESULTS: We searched Medline, CENTRAL, and other sources up to September 2004 for randomized trials. Individual and pooled random-effect odd ratios (OR) and 95% confidence intervals (CI) [OR (95% CI)] were calculated for the combined endpoint of all cause death and thromboembolic stroke (CEP), major bleeds (intra and extracranial), and systemic embolism. Number needed to treat (NNT) to avoid one CEP and heterogeneity were also assessed. Five studies enrolling 5239 patients with AF compared rate-control vs. rhythm-control. Average follow-up ranged from 1 to 3.5 years. A rate-control strategy compared with a rhythm-control approach was associated with a significantly reduced risk of CEP [OR 0.84 (0.73, 0.98), P=0.02], and with a trend towards a reduced risk of death [OR 0.87 (0.74, 1.02), P=0.09] and thromboembolic stroke [OR 0.80 (0.6, 1.07), P=0.14]. NNT to save one CEP was 50. There was no significant difference in the risk of major bleeds [OR 1.14 (0.9, 1.45), P=0.28] and systemic embolism [OR 0.93 (0.43, 2.02), P=0.90]. No significant heterogeneity was found in any of the analyses (P>0.1). CONCLUSION: This meta-analysis of 5239 patients with AF indicates that an initial rate-control strategy compared with a rhythm-control one is associated with a better prognosis, thus representing the standard treatment against which to test new therapeutic approaches.
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Testa et al. (2005) conducted a meta-analysis in First or recurrent atrial fibrillation (AF) (n=5,239). Rate-control strategy vs. Rhythm-control strategy was evaluated on Combined endpoint of all cause death and thromboembolic stroke (CEP) (OR 0.84, 95% CI 0.73, 0.98, p=0.02). A rate-control strategy significantly reduced the risk of the combined endpoint of all-cause death and thromboembolic stroke compared with a rhythm-control approach (OR 0.84; 95% CI 0.73-0.98; P=0.02).
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