TY - JOUR
T1 - Real-world applicability and impact of early rhythm control for European patients with atrial fibrillation
T2 - a report from the ESC-EHRA EORP-AF Long-Term General Registry
AU - Proietti, Marco
AU - Vitolo, Marco
AU - Harrison, Stephanie L
AU - Lane, Deirdre A
AU - Fauchier, Laurent
AU - Marin, Francisco
AU - Nabauer, Michael
AU - Potpara, Tatjana S
AU - Dan, Gheorghe-Andrei
AU - Boriani, Giuseppe
AU - Lip, Gregory Y H
AU - ESC-EHRA EORP-AF Long-Term General Registry Investigators
A2 - Joensen, Albert Marni
A2 - Gammelmark, Anders
A2 - Rasmussen, Lars Hvilsted
A2 - Dinesen, Pia Thisted
A2 - Riahi, Sam
A2 - Venø, Stine Krogh
A2 - Sorensen, B.
A2 - Korsgaard, Anne Marie
A2 - Andersen, K.
A2 - Hellum, Camilla Fragtrup
N1 - © 2021. The Author(s).
PY - 2022/1
Y1 - 2022/1
N2 - 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.
AB - 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.
KW - Atrial fibrillation
KW - Outcomes
KW - Rate control
KW - Rhythm control
UR - http://www.scopus.com/inward/record.url?scp=85113686615&partnerID=8YFLogxK
U2 - 10.1007/s00392-021-01914-y
DO - 10.1007/s00392-021-01914-y
M3 - Journal article
C2 - 34448931
SN - 1861-0684
VL - 111
SP - 70
EP - 84
JO - Clinical Research in Cardiology
JF - Clinical Research in Cardiology
IS - 1
ER -