Key result
Targeted therapy of underlying conditions improved physical functioning (Δ12 vs Δ6, P=0.007) and general health compared to conventional therapy in patients with early persistent AF and HF.
Why the study?
Atrial fibrillation reduces quality of life, and the effects of targeted therapy for underlying conditions on quality of life in patients with AF and heart failure needed evaluation.
Does targeted therapy of underlying conditions improve quality of life in patients with early persistent atrial fibrillation and heart failure?
RCT (n=230)
Does targeted therapy of underlying conditions improve quality of life in patients with early persistent atrial fibrillation and heart failure?
Absolute Event Rate: 12% vs 6%
p-value: p=0.007
Targeted therapy of underlying conditions, including MRAs, statins, ACEi/ARBs, and cardiac rehabilitation, significantly improves quality of life in patients with early persistent AF and heart failure compared to conventional therapy.
Supports targeted comorbidity therapy to boost QoL in early persistent AF with HF; confirms RCT benefit over conventional care.
AIMS: Atrial fibrillation (AF) reduces quality of life (QoL). We aim to evaluate effects of targeted therapy of underlying conditions on QoL in patients with AF and heart failure (HF). METHODS AND RESULTS: The Routine versus Aggressive risk factor driven upstream rhythm Control for prevention of Early atrial fibrillation in heart failure (RACE 3) study randomized patients with early persistent AF and HF to targeted or conventional therapy. Both groups received guideline-driven treatment. The targeted group received four additional therapies: mineralocorticoid receptor antagonists; statins; angiotensin converting enzyme inhibitors and/or receptor blockers; and cardiac rehabilitation including physical activity, dietary restrictions, and counselling. Quality of life was analysed in 230 patients at baseline and 1 year with available Medical Outcomes Study Short-Form Health Survey (SF-36), University of Toronto AF Severity Scale (AFSS) questionnaires, and European Heart Rhythm Association (EHRA) class. Improvements in SF-36 subscales were larger in the targeted group for physical functioning (Δ12 ± 19 vs. Δ6 ± 22, P = 0.007), physical role limitations (Δ32 ± 41 vs. Δ17 ± 45, P = 0.018), and general health (Δ8 ± 16 vs. Δ0 ± 17, P < 0.001). Dyspnoea at rest improved more (Δ-0.8 ± 1.3 vs. Δ-0.4 ± 1.2, P = 0.018) and EHRA class was lower at 1-year follow-up in the targeted group. Patients with AF at 1 year, improvement in physical functioning (Δ9 ± 9 vs. Δ-3 ± 16, P = 0.001), general health (Δ7 ± 16 vs. Δ-7 ± 19, P = 0.004), and social functioning (Δ6 ± 23 vs. Δ-4 ± 16, P = 0.041) were larger in the targeted group. CONCLUSION: A strategy aiming to treat underlying conditions improved QoL more compared with conventional therapy in patients with early persistent AF and HF. Its benefit was even observed in patients in AF at 1 year. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov NCT00877643.
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With et al. (2018) conducted an RCT in Atrial fibrillation and heart failure (n=230). Targeted therapy (MRAs, statins, ACEi/ARBs, and cardiac rehabilitation) vs. Conventional therapy was evaluated on Quality of life (SF-36 physical functioning subscale) (p=0.007). Targeted therapy of underlying conditions improved physical functioning (Δ12 vs Δ6, P=0.007) and general health compared to conventional therapy in patients with early persistent AF and HF.
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