What is the clinical evidence from this study?

Study design: Cohort. Population: Early atrial fibrillation (n=7161). Intervention: Early rhythm control vs. Usual care (rate control). Primary outcome: Major cardiovascular events (MACE) (HR 0.75, 95% CI 0.61-0.96, p=0.02).

July 31, 2023Open Access

Early rhythm control strategy in early atrial fibrillation patients, a retrospective cohort study.

Key Result

Early rhythm control significantly reduced the risk of major cardiovascular events (HR 0.75) compared to usual care in patients with early atrial fibrillation.

Study Design

Type

Cohort (n=7,161)

Multicenter

Yes

Structured PICO

Does early rhythm control reduce major cardiovascular events in patients with early atrial fibrillation compared to usual care?

Population

7,161 adult patients (≥18 years) diagnosed with early atrial fibrillation (within 1 year), excluding those with ongoing cancer. Mean age 69 (usual care) / 66 (early rhythm control), 56-60% male, based in Yinzhou District, Ningbo City, China.

Intervention

Early rhythm control (ERC) using class I or III antiarrhythmic agents initiated within 12 months of first AF diagnosis, or subsequent rhythm control after initiating rate control within 90 days.

Comparator

Usual care (UC) consisting of rate control treatment (class II, IV, V antiarrhythmic agents) without any subsequent rhythm control treatment within 90 days.

Outcome

Major cardiovascular events (MACE), a composite of cardiovascular death, hospitalization attributed to non-fatal myocardial infarction, non-fatal ischemic stroke, or heart failure.composite

Early rhythm control in patients with early atrial fibrillation is associated with a significantly lower risk of major cardiovascular events, particularly heart failure, compared to usual rate control.

Main Result

Effect estimate: HR 0.75 (95% CI 0.61-0.96)

Absolute Event Rate: 14% vs 22%

p-value: p=0.02

Limitations

Relatively small sample size compared to previous real-world studies
Potential unmeasured confounding factors despite the use of inverse probability of treatment weighting
Did not consider drug switch as a possible scenario

Abstract

Abstract Introduction : Atrial fibrillation (AF) treatment strategy on whether to use rhythm control or usual care (UC) has been debated for decades. In early studies, these two strategies showed equivalent efficacy, but more recent studies based on CHA 2 DS 2 -VASc score indicated that early rhythm control (ERC) would benefit more than UC strategy. We hypothesized that ERC might benefit AF patients in other cardiovascular outcomes, regardless of CHA 2 DS 2 -VASc score. To clarify this, we conducted the current study. Methods : A retrospective cohort study was carried out using the Yinzhou Regional Health Care Database (YRHCD). We included all patients diagnosed with AF within 1 year, while excluding those without age/sex information, no ERC/UC treatment prescription, or with ongoing cancer. The primary outcome was major cardiovascular events (MACE). We used inverse probability of treatment weighting (IPTW) for covariates weighting. Results : In total, 7,161 patients diagnosed with early AF were included in this study, 2,248 and 4,913 were in ERC group and usual care group, respectively. During mean follow-up period 3.2 years (27,945 person-year), and after IPTW, the result remained similar for ERC showed significantly lower risk for MACE (HR: 0.750.61, 0.96, P =0.02), and heart failure (HR: 0.710.54,0.95, P =0.01). No significant results were found in stroke, cardiovascular death, or all-cause mortality. Conclusion : Early rhythm control is more beneficial to early AF patients than usual care for major cardiovascular events.

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