A rhythm-control strategy was associated with superior therapeutic success compared to rate control (60% vs 47%; OR 1.34, 95% CI 1.15-1.55, p=0.0002), but did not predict clinical events.
Observational (n=5,604)
Yes
Does a rhythm-control strategy improve therapeutic success and clinical outcomes compared to a rate-control strategy in patients with recent-onset atrial fibrillation?
In a real-world setting, rhythm control for recent-onset AF was associated with higher therapeutic success and less progression to permanent AF compared to rate control, though clinical event rates were similar.
Effect estimate: OR 1.34 (95% CI 1.15-1.55)
Absolute Event Rate: 60% vs 47%
p-value: p=0.0002
RECORDAF is the first worldwide, prospective, observational survey of management of atrial fibrillation (AF) in unselected, community-based patients.Primary outcomes were therapeutic success and clinical outcomes associated with rhythm-control and rate-control strategies.Patients with recent-onset AF were included (n = 5,604). Treatment strategy (rhythm control or rate control) was noted at baseline. Follow-up was 12 months. Therapeutic success required that strategy was unchanged without clinical events. Further maintenance of sinus rhythm was required in the rhythm-control group, and heart rate ?80 beats/min in the rate-control group.Data from 5,171 patients were assessable. Therapeutic success was 54% overall (rhythm control 60% vs. rate control 47%), a result driven by control of AF: rhythm control, 81% vs. rate control, 74%. After adjustment for propensity score quintiles, the rhythm-control strategy was significantly related to superior therapeutic success (odds ratio: 1.34, 95% confidence interval: 1.15 to 1.55; p = 0.0002). Clinical events occurred in 18% of patients. The arrhythmia management strategy was not predictive of clinical events. The type (persistent), presence at baseline visit, and duration (>3 months) of AF, together with age older than 75 years and the presence of heart failure, predicted progression to permanent AF. The choice of rhythm control reduced the likelihood of AF progression (odds ratio: 0.20, 95% confidence interval: 0.17 to 0.25; p <0.0001).Clinical outcomes in AF patients were driven mainly by hospitalizations for arrhythmia/proarrhythmia and other cardiovascular causes, but not by the choice of rate or rhythm strategy. Rhythm-control patients progressed less rapidly to permanent AF. American College of Cardiology Foundation. Original language English Pages (from-to) 493-501 Number of pages 9 Journal Journal of the American College of Cardiology Volume 58 Issue number 5 DOIs https://doi.org/10.1016/j.jacc.2011.03.034 Publication status Published - 26 Jul 2011 Keywords atrial fibrillation rate control rhythm control
Camm et al. (Fri,) conducted a observational in Atrial fibrillation (n=5,604). Rhythm-control strategy vs. Rate-control strategy was evaluated on Therapeutic success (strategy unchanged without clinical events, and maintenance of sinus rhythm or heart rate ≤80 beats/min) (OR 1.34, 95% CI 1.15-1.55, p=0.0002). A rhythm-control strategy was associated with superior therapeutic success compared to rate control (60% vs 47%; OR 1.34, 95% CI 1.15-1.55, p=0.0002), but did not predict clinical events.