Real-world applicability and impact of early rhythm control for European patients with atrial fibrillation: a report from the ESC-EHRA EORP-AF Long-Term General Registry.
Atrial fibrillation
Outcomes
Rate control
Rhythm control
Journal
Clinical research in cardiology : official journal of the German Cardiac Society
ISSN: 1861-0692
Titre abrégé: Clin Res Cardiol
Pays: Germany
ID NLM: 101264123
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
received:
13
04
2021
accepted:
20
07
2021
pubmed:
28
8
2021
medline:
15
2
2022
entrez:
27
8
2021
Statut:
ppublish
Résumé
Use of rate/rhythm control is essential to control symptoms in patients with atrial fibrillation (AF). Recently, the EAST-AFNET 4 trial described how early rhythm control strategy was associated with a lower risk of adverse clinical outcomes. The aim was to evaluate the real-world applicability and impact of an early rhythm control strategy in patients with AF. Use of an early rhythm control strategy was assessed in a European cohort of AF patients derived from the EHRA-ESC EORP-AF General Long-Term Registry. Early rhythm control was defined as use of antiarrhythmic drugs or cardioversion/catheter ablation. The primary outcome included cardiovascular death, stroke, acute coronary syndrome, and worsening of heart failure. Quality of life and health-care resource usage were also assessed as outcomes. Among the 10,707 patients evaluated for eligibility to EAST-AFNET 4, a total of 3774 (34.0%) were included. Early rhythm control was associated with better quality of life, but with greater use of health-care resources. During follow-up, the primary outcome occurred less often in early rhythm control patients than in those with no rhythm control (13.6% vs. 18.5%, p < 0.001). In the multivariate adjusted Cox regression model, no significant difference was found between no rhythm control and early rhythm control, for the primary outcome. No difference in the primary outcome between early rhythm control and 'no rhythm control patients' adherent to Atrial fibrillation Better Care (ABC) pathway' was evident (p = 0.753) CONCLUSIONS: Use of an early rhythm control strategy was associated with a lower rate of major adverse events, but this difference was non-significant on multivariate analysis, being mediated by differences in baseline characteristics and clinical risk profile. Early rhythm control was associated with a higher use of health-care resources and risk of hospital admission, despite showing better quality of life.
Sections du résumé
BACKGROUND
BACKGROUND
Use of rate/rhythm control is essential to control symptoms in patients with atrial fibrillation (AF). Recently, the EAST-AFNET 4 trial described how early rhythm control strategy was associated with a lower risk of adverse clinical outcomes.
OBJECTIVES
OBJECTIVE
The aim was to evaluate the real-world applicability and impact of an early rhythm control strategy in patients with AF.
METHODS
METHODS
Use of an early rhythm control strategy was assessed in a European cohort of AF patients derived from the EHRA-ESC EORP-AF General Long-Term Registry. Early rhythm control was defined as use of antiarrhythmic drugs or cardioversion/catheter ablation. The primary outcome included cardiovascular death, stroke, acute coronary syndrome, and worsening of heart failure. Quality of life and health-care resource usage were also assessed as outcomes.
RESULTS
RESULTS
Among the 10,707 patients evaluated for eligibility to EAST-AFNET 4, a total of 3774 (34.0%) were included. Early rhythm control was associated with better quality of life, but with greater use of health-care resources. During follow-up, the primary outcome occurred less often in early rhythm control patients than in those with no rhythm control (13.6% vs. 18.5%, p < 0.001). In the multivariate adjusted Cox regression model, no significant difference was found between no rhythm control and early rhythm control, for the primary outcome. No difference in the primary outcome between early rhythm control and 'no rhythm control patients' adherent to Atrial fibrillation Better Care (ABC) pathway' was evident (p = 0.753) CONCLUSIONS: Use of an early rhythm control strategy was associated with a lower rate of major adverse events, but this difference was non-significant on multivariate analysis, being mediated by differences in baseline characteristics and clinical risk profile. Early rhythm control was associated with a higher use of health-care resources and risk of hospital admission, despite showing better quality of life.
Identifiants
pubmed: 34448931
doi: 10.1007/s00392-021-01914-y
pii: 10.1007/s00392-021-01914-y
pmc: PMC8766399
doi:
Substances chimiques
Anti-Arrhythmia Agents
0
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
70-84Informations de copyright
© 2021. The Author(s).
Références
N Engl J Med. 2020 Oct 1;383(14):1383-1384
pubmed: 32865379
Circ Arrhythm Electrophysiol. 2019 Sep;12(9):e007414
pubmed: 31431051
Thromb Haemost. 2018 Jul;118(7):1296-1304
pubmed: 29723875
Chest. 2010 Nov;138(5):1093-100
pubmed: 20299623
Circulation. 2012 Dec 4;126(23):2680-7
pubmed: 23124034
N Engl J Med. 2020 Oct 1;383(14):1305-1316
pubmed: 32865375
J Gerontol A Biol Sci Med Sci. 2007 Jul;62(7):722-7
pubmed: 17634318
Europace. 2019 Jul 1;21(7):1013-1022
pubmed: 30904925
Europace. 2017 May 1;19(5):722-733
pubmed: 27194538
N Engl J Med. 2002 Dec 5;347(23):1825-33
pubmed: 12466506
JACC Clin Electrophysiol. 2016 Apr;2(2):221-229
pubmed: 29766874
Am Heart J. 2013 Sep;166(3):442-8
pubmed: 24016492
Heart Rhythm. 2021 May;18(5):674-681
pubmed: 33383228
Int J Cardiol. 2018 Nov 15;271:68-74
pubmed: 30001945
Nat Rev Cardiol. 2017 Nov;14(11):627-628
pubmed: 28960189
Eur J Intern Med. 2020 Dec;82:105-111
pubmed: 33067121
Lancet. 2016 Aug 20;388(10046):818-28
pubmed: 27560277
PLoS One. 2017 Oct 26;12(10):e0186856
pubmed: 29073191
Eur Heart J. 2021 Feb 1;42(5):373-498
pubmed: 32860505
Europace. 2021 Feb 5;23(2):174-183
pubmed: 33006613
BMC Geriatr. 2017 Oct 10;17(1):230
pubmed: 29017448
Europace. 2018 Dec 1;20(12):1936-1943
pubmed: 29947751
Eur Heart J. 2014 Dec 14;35(47):3365-76
pubmed: 25176940
Europace. 2014 Mar;16(3):308-19
pubmed: 24351881
J Am Coll Cardiol. 2018 Jan 16;71(2):122-132
pubmed: 29325634
Thromb Haemost. 2021 May 21;:
pubmed: 34020488
Thromb Haemost. 2018 Apr;118(4):768-777
pubmed: 29510426
Eur Heart J. 2020 Nov 1;41(41):3987-3988
pubmed: 33099598
Chest. 2010 Feb;137(2):263-72
pubmed: 19762550
J Am Coll Cardiol. 2020 Apr 7;75(13):1523-1534
pubmed: 32241367
J Clin Med. 2020 Apr 24;9(4):
pubmed: 32344603
Ann Intern Med. 2014 Jun 3;160(11):760-73
pubmed: 24887617
N Engl J Med. 2018 Feb 01;378(5):417-427
pubmed: 29385358
Europace. 2018 Jun 1;20(6):929-934
pubmed: 29016989
Europace. 2018 May 1;20(5):747-757
pubmed: 29016832
Europace. 2018 Feb 1;20(2):243-252
pubmed: 28160483
Europace. 2016 Oct;18(10):1455-1490
pubmed: 27402624
Am J Med. 2020 Oct;133(10):1195-1202.e2
pubmed: 32289310