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May enhance rhythm outcomes with all 4 targeted therapies in early AF-HF; leaves open optimal intensity before practice change.
Introduction: Atrial fibrillation (AF) is a progressive disease. Many risk factors have been described for AF. Purpose: We sought to explore the outcome between all 4 targeted therapies of underlying conditions, less than 4 targeted therapies and conventional therapy in patients with early persistent AF and early mild to moderate heart failure (HF). Methods: We analyzed outcome in patients from the prospective, randomized, multicenter Routine vs. Aggressive risk factor driven upstream rhythm Control for prevention of Early atrial fibrillation in heart failure (RACE 3) study. The intervention group received 4 therapies on top of conventional care: 1) mineralocorticoid receptor antagonist, 2) angiotensin converting enzyme inhibitor, 3) statin, 4) cardiac rehabilitation including physical activity, dietary restrictions, and counseling. For this analysis, we evaluated how many patients of the intervention group completed all 4 targeted therapies and how many completed less than 4 therapies and what the difference in outcomes were. Of the 245 patients, 119 patients were randomized to targeted therapy and 126 patients to conventional therapy. In the targeted therapy group 69 of 119 patients completed all 4 targeted therapies, 49 completed less than 4 targeted therapies. One had missing data and was therefore excluded from further analyses.
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Nguyen et al. (2018) studied this question.
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