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RESEARCH PRODUCT
Rate vs. rhythm control and adverse outcomes among European patients with atrial fibrillation
Dimitrios TahmatzidisMichał MazurekCécile LarocheSalvatore NovoMarco ProiettiMarco ProiettiGregory Y.h. LipGregory Y.h. LipGiuseppe BorianiGiuseppe BorianiYanish Purmahsubject
MaleTime FactorsRate controlAction PotentialsPilot Projects030204 cardiovascular system & hematologyAmiodaroneAction Potentials/drug effectsHeart Conduction System/drug effectsCardiologists0302 clinical medicineHeart RateRisk FactorsCause of DeathAtrial Fibrillation030212 general & internal medicineRegistriesPractice Patterns Physicians'Cause of deathAged 80 and overAll-cause death; Atrial fibrillation; Major adverse events; Rate control; Registry; Rhythm controlHeart Rate/drug effectsAtrial fibrillationMiddle AgedEuropeTreatment OutcomeCohortCardiologyHealthcare Disparities/trendsRhythm controlFemaleCardiology and Cardiovascular MedicineAnti-Arrhythmia AgentsCardiologists/trendsmedicine.drugmedicine.medical_specialtyMajor adverse eventsRegistryAll-cause deathAnti-Arrhythmia Agents/adverse effectsEurope/epidemiology03 medical and health sciencesHeart Conduction SystemPhysiology (medical)Internal medicineHeart ratemedicineAtrial Fibrillation/diagnosisHumansHealthcare DisparitiesAdverse effectAgedbusiness.industryProportional hazards modelmedicine.diseaseAtrial fibrillationPractice Patterns Physicians'/trendsAtrial fibrillation • Rate control • Rhythm control • Major adverse events • All-cause death • RegistryPropensity score matchingbusinessdescription
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.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2018-02-01 |