Early rhythm control reduced the risk of a composite cardiovascular outcome by 18.7% compared to rate control in patients with atrial fibrillation diagnosed within one year.
Cohort (n=22,635)
No
Does early versus late initiation of a rhythm control strategy reduce adverse cardiovascular outcomes compared to a rate control strategy in patients with atrial fibrillation?
Early initiation of rhythm control (within 1 year of diagnosis) is associated with improved cardiovascular outcomes compared to rate control in patients with atrial fibrillation, whereas late initiation shows no such benefit.
Effect estimate: HR 0.81 (95% CI 0.71 to 0.93)
Absolute Event Rate: 7.42% vs 9.25%
p-value: p=0.002
Abstract Objective To investigate whether the results of a rhythm control strategy differ according to the duration between diagnosis of atrial fibrillation and treatment initiation. Design Longitudinal observational cohort study. Setting Population based cohort from the Korean National Health Insurance Service database. Participants 22 635 adults with atrial fibrillation and cardiovascular conditions, newly treated with rhythm control (antiarrhythmic drugs or ablation) or rate control strategies between 28 July 2011 and 31 December 2015. Main outcome measure A composite outcome of death from cardiovascular causes, ischaemic stroke, admission to hospital for heart failure, or acute myocardial infarction. Results Of the study population, 12 200 (53.9%) were male, the median age was 70, and the median follow-up duration was 2.1 years. Among patients with early treatment for atrial fibrillation (initiated within one year since diagnosis), compared with rate control, rhythm control was associated with a lower risk of the primary composite outcome (weighted incidence rate per 100 person years 7.42 in rhythm control v 9.25 in rate control; hazard ratio 0.81, 95% confidence interval 0.71 to 0.93; P=0.002). No difference in the risk of the primary composite outcome was found between rhythm and rate control (weighted incidence rate per 100 person years 8.67 in rhythm control v 8.99 in rate control; 0.97, 0.78 to 1.20; P=0.76) in patients with late treatment for atrial fibrillation (initiated after one year since diagnosis). No significant differences in safety outcomes were found between the rhythm and rate control strategies across different treatment timings. Earlier initiation of treatment was linearly associated with more favourable cardiovascular outcomes for rhythm control compared with rate control. Conclusions Early initiation of rhythm control treatment was associated with a lower risk of adverse cardiovascular outcomes than rate control treatment in patients with recently diagnosed atrial fibrillation. This association was not found in patients who had had atrial fibrillation for more than one year.
Kim et al. (Tue,) conducted a cohort in Atrial Fibrillation (n=22,635). Rhythm control vs. Rate control was evaluated on Composite outcome of death from cardiovascular causes, ischaemic stroke, admission to hospital for heart failure, or acute myocardial infarction (HR 0.81, 95% CI 0.71 to 0.93, p=0.002). Early rhythm control reduced the risk of a composite cardiovascular outcome by 18.7% compared to rate control in patients with atrial fibrillation diagnosed within one year.