atrial fibrillation AF

 

Rhythm vs. Rate Control in Older Atrial Fibrillation Patients

Rhythm control might be superior in the long term.
In a major trial published in 2002 (AFFIRM; JW Gen Med Dec 13 2002), investigators found no difference in outcome between rhythm and rate control during 5 years of follow-up in patients with atrial fibrillation (AF). However, many clinicians still favor rhythm control. In this retrospective cohort study, researchers used a Canadian database to identify 26,000 hospitalized patients (median age, 77) with incident AF who were treated with rhythm or rate control. Patient follow-up was available for as long as 9 years (median, 3.1 years); during that time, half of the patients died.
Analyses were adjusted for many demographic and clinical confounders. Compared with rate control, rhythm control was associated with 7% higher mortality at 6 months, equal mortality through 4 years, and 11% and 23% lower mortality at years 5 and 8, respectively.
Comment: Results from this population-based older cohort are similar to those of AFFIRM — no difference between rhythm and rate control for AF during short-term and intermediate-term follow-up. In the current analysis, however, rhythm control was superior during longer follow-up. Because potential unidentified confounders can't be ruled out in a retrospective study, a long-term randomized trial would be justified to confirm these findings.
— Thomas L. Schwenk, MD
Published in Journal Watch General Medicine July 26, 2012

Citation(s):

• Medline abstract (Free)