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

Marco Proietti*, Marco Vitolo, Stephanie L Harrison, Deirdre A Lane, Laurent Fauchier, Francisco Marin, Michael Nabauer, Tatjana S Potpara, Gheorghe-Andrei Dan, Giuseppe Boriani, Gregory Y H Lip*, ESC-EHRA EORP-AF Long-Term General Registry Investigators, Albert Marni Joensen (Medlem af forfattergruppering), Anders Gammelmark (Medlem af forfattergruppering), Lars Hvilsted Rasmussen (Medlem af forfattergruppering), Pia Thisted Dinesen (Medlem af forfattergruppering), Sam Riahi (Medlem af forfattergruppering), Stine Krogh Venø (Medlem af forfattergruppering), B. Sorensen (Medlem af forfattergruppering), Anne Marie Korsgaard (Medlem af forfattergruppering)K. Andersen (Medlem af forfattergruppering), Camilla Fragtrup Hellum (Medlem af forfattergruppering)

*Kontaktforfatter

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

29 Citationer (Scopus)
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Abstract

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: The aim was to evaluate the real-world applicability and impact of an early rhythm control strategy in patients with AF.

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: 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.

OriginalsprogEngelsk
TidsskriftClinical Research in Cardiology
Vol/bind111
Udgave nummer1
Sider (fra-til)70-84
Antal sider15
ISSN1861-0684
DOI
StatusUdgivet - jan. 2022

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© 2021. The Author(s).

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