Key result
CAFFE study protocol investigates rhythm versus rate control for functional status and frailty in AF.
Why the study?
Guidelines do not indicate a preference for rhythm control versus rate control for atrial fibrillation management in older people, and the impact on frailty progression is unclear.
Does a rhythm control strategy improve functional status and reduce frailty in older patients with atrial fibrillation compared to a rate control strategy?
Cohort (n=160)
Yes
Does a rhythm control strategy improve functional status and reduce frailty in older patients with atrial fibrillation compared to a rate control strategy?
This observational cohort study protocol will prospectively evaluate whether restoring sinus rhythm better prevents the progression of frailty, cognitive decline, and disability compared to rate control in older patients with atrial fibrillation.
Does not support changing rate versus rhythm strategies in older AF patients; leaves open effects on frailty and function pending study completion.
Background: Atrial fibrillation (AF), highly prevalent in older individuals, is associated with frailty and disability. AF therapy is based on rhythm control (RhythmC) to restore sinus rhythm or rate control (RateC) to lower the heart rate. Published guidelines do not indicate a preference for one over the other for older people. Objective: This study aims to evaluate whether RhythmC is more effective than RateC in hindering the progression of frailty and disability. Methods: The Cardioversion of Atrial Fibrillation and Frailty in the Elderly (CAFFE) study is a prospective, multicenter, observational cohort study that includes 4 groups of patients: (1) adults age 75 years or older undergoing RhythmC treatment; (2) adults aged 65 to 74 years undergoing RhythmC treatment; (3) adults 65 years or older undergoing RateC treatment; and (4) adults 65 years or older without overt chronic conditions as the control group (n=40 in each group). At baseline, all participants will undergo a Comprehensive Geriatric Assessment (CGA) and analyses of inflammation and metabolomics. At home, a device will evaluate each participant's heart rhythm, activity profile, and sleep. After 1 month, the CGA will be repeated. Results: -VA score 4.2, SD 1.2; 13 [43.3%] robust participants). All centers are now completing the enrollment (103/160 participants), and the analysis of inflammatory mediators has started. The results are expected to be published in summer 2027. Conclusions: The CAFFE study will evaluate the effectiveness of AF management strategies in older patients. If RhythmC can slow the progression of frailty and disability, specific clinical trials should more definitively address this knowledge gap.
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Berni et al. (2026) conducted a cohort in Atrial Fibrillation (n=160). Rhythm control strategy vs. Rate control strategy was evaluated on Improvement in functional status at 1-month follow-up measured by a 1-point increase in the Short Physical Performance Battery (SPPB). The CAFFE study protocol outlines an ongoing prospective cohort study designed to evaluate whether rhythm control is more effective than rate control in improving functional status and slowing frailty progression in older patients with atrial fibrillation.
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