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.

Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St George's University of London London the United Kingdom of Great Britain and Northern Ireland

Department of Cardiology Oslo University Hospital Ullevål Oslo Norway

Department of Cardiovascular Surgery Motol University Hospital Prague Czech Republic

Department of Medicine Ramathibodi Hospital Mahidol University Thailand

Institute of Clinical Medicine University of Oslo Oslo Norway

National Medical Research Center of Cardiology of Ministry of Health of the Russian Federation Moscow Russian Federation

Servicio de Cardiología y Cirugía Cardíaca Hospital Universitario Virgen del Rocío Universidad de Sevilla Sevilla Departamento Cardiovascular Instituto de Biotecnología de Sevilla Spain

Sylvia Haas Formerly Department of Medicine Technical University of Munich Munich Germany

Thrombosis Research Institute London the United Kingdom of Great Britain and Northern Ireland

Tokai University Kanagawa Japan

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