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Rhythm versus rate control in patients with newly diagnosed atrial fibrillation - Observations from the GARFIELD-AF registry

M. Knudsen Pope, TS. Hall, S. Virdone, D. Atar, A. John Camm, KS. Pieper, P. Jansky, S. Haas, S. Goto, E. Panchenko, G. Baron-Esquivias, P. Angchaisuksiri, AK. Kakkar, GARFIELD-AF Investigators

. 2023 ; 49 (-) : 101302. [pub] 20231116

Status neindexováno Jazyk angličtina Země Irsko

Typ dokumentu časopisecké články

Perzistentní odkaz   https://www.medvik.cz/link/bmc23022413

BACKGROUND: Investigate real-world outcomes of early rhythm versus rate control in patients with recent onset atrial fibrillation. METHODS: The Global Anticoagulant Registry in the FIELD-AF (GARFIELD-AF) is an international multi-centre, non-interventional prospective registry of newly diagnosed (≤6 weeks' duration) atrial fibrillation patients at risk for stroke. Patients were stratified according to treatment initiated at baseline (≤48 days post enrolment), and outcome risks evaluated by overlap propensity weighted Cox proportional-hazards models. RESULTS: Of 45,382 non-permanent atrial fibrillation patients, 23,858 (52.6 %) received rhythm control and 21,524 (47.4 %) rate control. Rhythm-controlled patients had lower median age (68.0 [Q1;Q3: 60.0;76.0] versus 73.0 [65.0;79.0]), fewer histories of stroke/transient ischemic attack/systemic embolism (9.4 % versus 13.0 %), and lower expected probabilities of death (median GARFIELD-AF death score 4.0 [2.3;7.5] versus 5.1 [2.8;9.2]). The two groups had the same median CHA2DS2-VASc scores (3.0 [2.0;4.0]) and similar proportions of anticoagulated patients (rhythm control: 66.0 %, rate control: 65.5 %). The propensity-score-weighted hazard ratios of rhythm vs rate control (reference) were 0.85 (95 % CI: 0.79-0.92, p-value < 0.0001) for all-cause mortality, 0.84 (0.72-0.97, p-value 0.020) for non-haemorrhagic stroke/systemic embolism and 0.90 (0.78-1.04, p-value 0.164) for major bleeding. CONCLUSION: Rhythm control strategy was initiated in about half of the patients with newly diagnosed non-valvular non-permanent atrial fibrillation. After balancing confounders, significantly lower risks of all-cause mortality and non-haemorrhagic stroke were observed in patients who received early rhythm control.

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$a BACKGROUND: Investigate real-world outcomes of early rhythm versus rate control in patients with recent onset atrial fibrillation. METHODS: The Global Anticoagulant Registry in the FIELD-AF (GARFIELD-AF) is an international multi-centre, non-interventional prospective registry of newly diagnosed (≤6 weeks' duration) atrial fibrillation patients at risk for stroke. Patients were stratified according to treatment initiated at baseline (≤48 days post enrolment), and outcome risks evaluated by overlap propensity weighted Cox proportional-hazards models. RESULTS: Of 45,382 non-permanent atrial fibrillation patients, 23,858 (52.6 %) received rhythm control and 21,524 (47.4 %) rate control. Rhythm-controlled patients had lower median age (68.0 [Q1;Q3: 60.0;76.0] versus 73.0 [65.0;79.0]), fewer histories of stroke/transient ischemic attack/systemic embolism (9.4 % versus 13.0 %), and lower expected probabilities of death (median GARFIELD-AF death score 4.0 [2.3;7.5] versus 5.1 [2.8;9.2]). The two groups had the same median CHA2DS2-VASc scores (3.0 [2.0;4.0]) and similar proportions of anticoagulated patients (rhythm control: 66.0 %, rate control: 65.5 %). The propensity-score-weighted hazard ratios of rhythm vs rate control (reference) were 0.85 (95 % CI: 0.79-0.92, p-value < 0.0001) for all-cause mortality, 0.84 (0.72-0.97, p-value 0.020) for non-haemorrhagic stroke/systemic embolism and 0.90 (0.78-1.04, p-value 0.164) for major bleeding. CONCLUSION: Rhythm control strategy was initiated in about half of the patients with newly diagnosed non-valvular non-permanent atrial fibrillation. After balancing confounders, significantly lower risks of all-cause mortality and non-haemorrhagic stroke were observed in patients who received early rhythm control.
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$a Virdone, Saverio $u Thrombosis Research Institute, London, the United Kingdom of Great Britain and Northern Ireland
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$a Atar, Dan $u Institute of Clinical Medicine, University of Oslo, Oslo, Norway $u Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
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$a John Camm, A $u Cardiology Clinical Academic Group Molecular & Clinical Sciences Research Institute, St. George's University of London, London, the United Kingdom of Great Britain and Northern Ireland
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$a Pieper, Karen S $u Thrombosis Research Institute, London, the United Kingdom of Great Britain and Northern Ireland
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$a Jansky, Petr $u Department of Cardiovascular Surgery, Motol University Hospital, Prague, Czech Republic
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$a Haas, Sylvia $u Sylvia Haas: Formerly Department of Medicine, Technical University of Munich, Munich, Germany
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$a Goto, Shinya $u Tokai University, Kanagawa, Japan
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$a Panchenko, Elizaveta $u National Medical Research Center of Cardiology of Ministry of Health of the Russian Federation, Moscow, Russian Federation
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$a Baron-Esquivias, Gonzalo $u Servicio de Cardiología y Cirugía Cardíaca, Hospital Universitario Virgen del Rocío., Universidad de Sevilla., Sevilla. Departamento Cardiovascular, Instituto de Biotecnología de Sevilla (IBIS), Spain
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$a Angchaisuksiri, Pantep $u Department of Medicine, Ramathibodi Hospital, Mahidol University, Thailand
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$a Kakkar, Ajay K $u Thrombosis Research Institute, London, the United Kingdom of Great Britain and Northern Ireland
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