Beta-blockers were the most effective first-line drugs for achieving overall rate control in atrial fibrillation (70%), compared to calcium channel blockers (54%) and digoxin (58%).
RCT (n=2,027)
randomized
Does the choice of rate-controlling drug class affect the efficacy of rate control in patients with atrial fibrillation?
Beta-blockers are the most effective first-line agents for achieving rate control in atrial fibrillation, though frequent medication changes and combinations are often required.
Absolute Event Rate: 70% vs 54%
OBJECTIVES: We sought to evaluate approaches used to control rate, the effectiveness of rate control, and switches from one drug class to another in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. BACKGROUND: The AFFIRM study showed that atrial fibrillation (AF) can be treated effectively with rate control and anticoagulation, but drug efficacy to control rate remains uncertain. METHODS: Patients (n = 2,027) randomized to rate control in the AFFIRM study were given rate-controlling drugs by their treating physicians. Standardized rate-control efficacy criteria developed a priori included resting heart rate and 6-min walk tests and/or ambulatory electrocardiographic results. RESULTS: Average follow-up was 3.5 +/- 1.3 years. Initial treatment included a beta-adrenergic blocker (beta-blocker) alone in 24%, a calcium channel blocker alone in 17%, digoxin alone in 16%, a beta-blocker and digoxin in 14%, or a calcium channel blocker and digoxin in 14% of patients. Overall rate control was achieved in 70% of patients given beta-blockers as the first drug (with or without digoxin), 54% with calcium channel blockers (with or without digoxin), and 58% with digoxin alone. Adequate overall rate control was achieved in 58% of patients with the first drug or combination. Multivariate analysis revealed an association between first drug class and several clinical variables. There were more changes to beta-blockers than to the other two-drug classes (p < 0.0001). CONCLUSIONS: Rate control in AF is possible in the majority of patients with AF. Beta-blockers were the most effective drugs. To achieve the goal of adequate rate control in all patients, frequent medication changes and drug combinations were needed.
“This study has important implications for treatment. It appears that the preferred therapy for many patients with atrial fibrillation may be a strategy to control the heart rate.”
Olshansky et al. (2004) conducted an RCT in Atrial fibrillation (n=2,027). Beta-blockers vs. Calcium channel blockers or digoxin was evaluated on Overall rate control (resting heart rate and 6-min walk tests and/or ambulatory electrocardiographic results). Beta-blockers were the most effective first-line drugs for achieving overall rate control in atrial fibrillation (70%), compared to calcium channel blockers (54%) and digoxin (58%).