Key result
Patient-specific rate control with diltiazem linked to ~55% lower one-year mortality in AF with HF.
Why the study?
Atrial fibrillation requires personalised treatment, but the prognostic impact of patient-specific rate control therapy compared to standard guideline-defined therapy was unclear.
Does patient-specific therapy including diltiazem improve one-year survival in patients with atrial fibrillation on rate control compared to standard therapy?
Case-Control (n=1,112)
No
Does patient-specific therapy including diltiazem improve one-year survival in patients with atrial fibrillation on rate control compared to standard therapy?
The use of diltiazem for rate control in atrial fibrillation, even in selected patients with heart failure, may be safe and potentially improve survival compared to standard beta-blocker therapy alone.
Answers are grounded in this paper and cite their sources.
Patient-specific diltiazem rate control was associated with lower mortality in AF-HF; hypothesis-generating and requires RCT confirmation.
Atrial fibrillation (AF) is a multifaceted disease requiring personalised treatment. The aim of our study was to explore the prognostic impact of a patient-specific therapy (PT) for rate control, including the use of non-dihydropyridine calcium channel blockers (NDDC) in patients with heart failure (HF) or in combination with beta-blockers (BB), compared to standard rate control therapy (ST), as defined by previous ESC guidelines. This is a single-centre prospective observational registry on AF patients who were followed by our University Hospital. We included 1112 patients on an exclusive rate control treatment. The PT group consisted of 125 (11.2%) patients, 93/125 (74.4%) of whom were prescribed BB + NDCC (±digoxin), while 85/125 (68.0%) were HF patients who were prescribed NDCC, which was diltiazem in all cases. The patients treated with a PT showed no difference in one-year overall survival compared to those with an ST. Notably, the patients with HF in ST had a worse prognosis (p < 0.001). To better define this finding, we performed three sensitivity analyses by matching each patient in the PT subgroups with three subjects from the ST cohort, showing an improved one-year survival of the HF patients treated with PT (p = 0.039). Our results suggest a potential outcome benefit of NDCC for rate control in AF patients, either alone or in combination with BB and in selected patients with HF.
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Diemberger et al. (2022) conducted a case-control in Atrial fibrillation on exclusive rate control (n=1,112). Patient-specific therapy (diltiazem alone or with beta-blockers) vs. Standard rate control therapy (ESC guidelines) was evaluated on One-year mortality (matched heart failure subgroup) (p=0.039). Patient-specific rate control therapy including diltiazem improved one-year survival in atrial fibrillation patients with heart failure compared to standard therapy.
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