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March 8, 2004Circulation

Relationships Between Sinus Rhythm, Treatment, and Survival in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Study

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Why the study?

Does the presence of sinus rhythm, warfarin use, or antiarrhythmic drugs improve survival in patients with atrial fibrillation and high risk for stroke or death?

Population

Patients with atrial fibrillation and a high risk for stroke or death from the AFFIRM study

Comparison

Presence of sinus rhythm, warfarin use, and… vs Absence of sinus rhythm, no warfarin use, and no…

Design

Cohort

Discussion

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Overview

Supports survival associations with sinus rhythm and warfarin in high-risk AF; leaves open net benefit of antiarrhythmic therapy.

Key Points

  • To evaluate the longitudinal relationships among cardiac rhythm, pharmacological therapies, and overall survival in patients with atrial fibrillation at high risk for stroke or death.
  • Conducted an on-treatment survival analysis utilizing clinical data from the AFFIRM study cohort.
  • Applied multivariable modeling techniques incorporating baseline clinical characteristics and time-dependent variables for cardiac rhythm and drug therapies.
  • Presence of sinus rhythm and use of warfarin were both independently associated with a significantly reduced risk of mortality over time.
  • Baseline predictors of increased mortality included older age, coronary artery disease, congestive heart failure, diabetes, prior stroke or transient ischemic attack, smoking, left ventricular dysfunction, and mitral regurgitation.
  • Antiarrhythmic drug therapy was associated with increased mortality only after adjusting for sinus rhythm, and showed no survival benefit when sinus rhythm was excluded from the model.

Structured PICO

Does the presence of sinus rhythm, warfarin use, or antiarrhythmic drugs improve survival in patients with atrial fibrillation and high risk for stroke or death?

P
Population
Patients with atrial fibrillation and a high risk for stroke or death from the AFFIRM study
I
Intervention
Presence of sinus rhythm, warfarin use, and antiarrhythmic drugs (AADs) evaluated as time-dependent variables
C
Comparator
Absence of sinus rhythm, no warfarin use, and no antiarrhythmic drugs
O
Outcome
Survival (risk of death)hard clinical

In high-risk patients with atrial fibrillation, maintaining sinus rhythm and using warfarin are associated with improved survival, but the adverse effects of currently available antiarrhythmic drugs appear to offset the survival benefits of sinus rhythm.

Cite This Study

A 2004 study studied this question.

synapsesocial.com/papers/6a7ddaaa87be3f923b5ca8c0https://doi.org/10.1161/01.cir.0000121736.16643.11
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Analysis of Cause-Specific Mortality in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Study2004 · 230 citations
  2. 2A Comparison of Rate Control and Rhythm Control in Patients with Atrial Fibrillation2002 · 4,439 citations
  3. 3The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study2004 · 592 citations
  4. 4Warfarin, Aspirin, or Both after Myocardial Infarction2002 · 850 citations
  5. 5Effect of the Antiarrhythmic Agent Moricizine on Survival after Myocardial Infarction1992 · 1,012 citations