Rhythm Control Versus Rate Control and Clinical Outcomes in Patients With Atrial Fibrillation: Results From the ORBIT-AF Registry.

Published

Journal Article

OBJECTIVES: The study sought to evaluate clinical outcomes in clinical practice with rhythm control versus rate control strategy for management of atrial fibrillation (AF). BACKGROUND: Randomized trials have not demonstrated significant differences in stroke, heart failure, or mortality between rhythm and rate control strategies. The comparative outcomes in contemporary clinical practice are not well described. METHODS: Patients managed with a rhythm control strategy targeting maintenance of sinus rhythm were retrospectively compared with a strategy of rate control alone in a AF registry across various U.S. practice settings. Unadjusted and adjusted (inverse-propensity weighted) outcomes were estimated. RESULTS: The overall study population (N = 6,988) had a median of 74 (65 to 81) years of age, 56% were males, 77% had first detected or paroxysmal AF, and 68% had CHADS2 score ≥2. In unadjusted analyses, rhythm control was associated with lower all-cause death, cardiovascular death, first stroke/non-central nervous system systemic embolization/transient ischemic attack, or first major bleeding event (all p < 0.05); no difference in new onset heart failure (p = 0.28); and more frequent cardiovascular hospitalizations (p = 0.0006). There was no difference in the incidence of pacemaker, defibrillator, or cardiac resynchronization device implantations (p = 0.99). In adjusted analyses, there were no statistical differences in clinical outcomes between rhythm control and rate control treated patients (all p > 0.05); however, rhythm control was associated with more cardiovascular hospitalizations (hazard ratio: 1.24; 95% confidence interval: 1.10 to 1.39; p = 0.0003). CONCLUSIONS: Among patients with AF, rhythm control was not superior to rate control strategy for outcomes of stroke, heart failure, or mortality, but was associated with more cardiovascular hospitalizations.

Full Text

Duke Authors

Cited Authors

  • Noheria, A; Shrader, P; Piccini, JP; Fonarow, GC; Kowey, PR; Mahaffey, KW; Naccarelli, G; Noseworthy, PA; Reiffel, JA; Steinberg, BA; Thomas, LE; Peterson, ED; Gersh, BJ; ORBIT-AF Investigators and Patients,

Published Date

  • April 2016

Published In

Volume / Issue

  • 2 / 2

Start / End Page

  • 221 - 229

PubMed ID

  • 29766874

Pubmed Central ID

  • 29766874

Electronic International Standard Serial Number (EISSN)

  • 2405-5018

Digital Object Identifier (DOI)

  • 10.1016/j.jacep.2015.11.001

Language

  • eng

Conference Location

  • United States