Journal
INTERNATIONAL JOURNAL OF CARDIOLOGY
Volume 270, Issue -, Pages 154-159Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.ijcard.2018.06.090
Keywords
Atrial fibrillation; Rhythm control; Rate control; Stroke; Mortality
Categories
Funding
- Taichung Veterans General Hospital, Taiwan [TCVGH-NHRI10603, TCVGH-1067310C, TCVGH-FCU1068205, TCVGH-YM1060201, TCVGH-VTA106PREM1, TCVGH-1033103C, TCVGH-1033105C, TCVGH-1043109C, TCVGH-1053108C, TCVGH-VHCY1068606, TCVGH-VHCY1078603]
- National Science Council, Taiwan [102-2314-B-075A-009-MY2, 104-2314- B-367-001, 105-2314-B-075A-016-MY3]
Ask authors/readers for more resources
Background: Atrial fibrillation (AF) increases the risk of stroke and mortality. However, rhythm control strategy did not reduce cardiovascular risks in short-term studies. We hypothesize that rhythm control better prevents stroke and mortality than rate control in AF patients over a long-term period. Methods: AF patients aged >= 18 years were identified from Taiwan National Insurance Database. Patients using anti-arrhythmia drugs to control rhythm at a >30 defined daily dose (DDD) were defined as the rhythm control group. Patients who used rate control medications for >30 DDDs constituted the rate control group. Multivariate Cox hazards regression model was used to evaluate the hazard ratio (HR) for major adverse cardiovascular events (MACE), including ischemic/hemorrhagic stroke and mortality. Results: A total of 11,968 AF patients were enrolled, and 2850 of them(654 in rhythm control group; 2196 in rate control group) were analyzed. During a 6.3 +/- 3.7 year's follow-up, a total of 1101 MACE occurred. Compared to rate control group, rhythm control group displayed a lower rate of ischemic stroke (adjusted HR: 0.65, p = 0.002) and mortality (adjusted HR: 0.81, p = 0.009). The rhythm control group showed a lower incidence of MACE than that of the rate control group (adjusted HR: 0.82, p = 0.009). The reduction of stroke (p = 0.004), mortality (p = 0.006), and MACE (p = 0.007) risk was observed particularly in rhythm control patients with a CHA2DS2-VASc score of >= 3. Conclusions: In patients with AF, rhythm control better prevents MACE risk than rate control over a long-term period, particularly in those at high risk (CHA2DS2-VASc score >= 3) for stroke. (c) 2018 Elsevier B.V. All rights reserved.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available