Key result
Rate control shows no significant difference in all-cause death compared to rhythm control in AF.
Why the study?
The impact of rate and rhythm control strategies on outcomes in patients with atrial fibrillation remains controversial.
Does a rate control strategy compared to a rhythm control strategy affect the risk of adverse events and all-cause death in patients with atrial fibrillation?
Observational (n=3,119)
Yes
Does a rate control strategy compared to a rhythm control strategy affect the risk of adverse events and all-cause death in patients with atrial fibrillation?
p-value: p=0.0664
In a European registry of AF patients, the higher unadjusted risk of death with rate control compared to rhythm control appears largely driven by underlying comorbidities rather than the strategy itself.
Rate control was associated with higher 1-year mortality in unadjusted registry data; leaves open whether strategy independently affects outcomes.
Aim: The impact of rate and rhythm control strategies on outcomes in patients with atrial fibrillation (AF) remains controversial. Our aims were: to report use of rate and rhythm control strategies in European patients from the EURObservational Research Program AF General Pilot Registry. Secondly, to evaluate outcomes according to assigned strategies. Methods and results: Use of pure rate and rhythm control agents was described according to European regions. 1-year follow-up data were reported. Among rate control strategies, beta-blockers were the most commonly used drug. Proportions of patients assigned to rhythm control varied greatly between countries, and amiodarone was the most used rhythm control drug. Of the original 3119 patients, 1036 (33.2%) were assigned to rate control only and 355 (11.4%) to rhythm control only. Patients assigned to a rate control strategy were older (P < 0.0001) and more likely female (P = 0.0266). Patients assigned to a rate control strategy had higher rates for any thrombo-embolic event (P = 0.0245), cardiovascular death (P = 0.0437), and all-cause death (P < 0.0001). Kaplan-Meier analysis showed that rate control strategy was associated with a higher risk for all-cause death (P < 0.001). On Cox regression analysis, rate control strategy was independently associated with all-cause death (P = 0.0256). A propensity matched analysis only found a trend for the association between rate control and all-cause death (P = 0.0664). Conclusion: In a European AF patients' cohort, a pure rate control strategy was associated with a higher risk for adverse events at 1-year follow-up, and partially adjusted analysis suggested that rate control independently increased the risk for all-cause death. A fully adjusted propensity score matched analysis found that this association was no longer statistically significant, suggesting an important role of comorbidities in determining the higher risk for all-cause death.
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Purmah et al. (2017) conducted an observational in Atrial fibrillation (n=3,119). Rate control strategy vs. Rhythm control strategy was evaluated on All-cause death (p=0.0664). A rate control strategy in patients with atrial fibrillation was not significantly associated with a higher risk of all-cause death compared to rhythm control after propensity score matching (P=0.0664).
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