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Rhythm Control Versus Rate Control in Patients With Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction: Insights From Get With The Guidelines-Heart Failure.

Publication ,  Journal Article
Kelly, JP; DeVore, AD; Wu, J; Hammill, BG; Sharma, A; Cooper, LB; Felker, GM; Piccini, JP; Allen, LA; Heidenreich, PA; Peterson, ED; Yancy, CW ...
Published in: J Am Heart Assoc
December 17, 2019

Background Limited data exist to guide treatment for patients with heart failure with preserved ejection fraction and atrial fibrillation, including the important decision regarding rate versus rhythm control. Methods and Results We analyzed the Get With The Guidelines-Heart Failure (GWTG-HF) registry linked to Medicare claims data from 2008 to 2014 to describe current treatments for rate versus rhythm control and subsequent outcomes in patients with heart failure with preserved ejection fraction and atrial fibrillation using inverse probability weighted analysis. Rhythm control was defined as use of an antiarrhythmic medication, cardioversion, or AF ablation or surgery. Rate control was defined as use of any combination of β-blocker, calcium channel blocker, and digoxin without evidence of rhythm control. Among 15 682 fee-for-service Medicare patients, at the time of discharge, 1857 were treated with rhythm control and 13 825 with rate control, with minimal differences in baseline characteristics between groups. There was higher all-cause death at 1 year in the rate control compared with the rhythm control group (37.5% and 30.8%, respectively, P<0.01). The lower 1-year all-cause death in the rhythm control group remained after risk adjustment (adjusted hazard ratio, 0.86; 95% CI, 0.75-0.98; P=0.02). Conclusions Rhythm control in patients aged 65 and older with heart failure with preserved ejection fraction and AF was associated with a lower risk of 1 year all-cause mortality. Future prospective randomized studies are needed to explore this potential benefit.

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Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

December 17, 2019

Volume

8

Issue

24

Start / End Page

e011560

Location

England

Related Subject Headings

  • Stroke Volume
  • Retrospective Studies
  • Practice Guidelines as Topic
  • Male
  • Humans
  • Heart Rate
  • Heart Failure
  • Female
  • Atrial Fibrillation
  • Aged, 80 and over
 

Citation

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Kelly, J. P., DeVore, A. D., Wu, J., Hammill, B. G., Sharma, A., Cooper, L. B., … Hernandez, A. F. (2019). Rhythm Control Versus Rate Control in Patients With Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction: Insights From Get With The Guidelines-Heart Failure. J Am Heart Assoc, 8(24), e011560. https://doi.org/10.1161/JAHA.118.011560
Kelly, Jacob P., Adam D. DeVore, JingJing Wu, Bradley G. Hammill, Abhinav Sharma, Lauren B. Cooper, G Michael Felker, et al. “Rhythm Control Versus Rate Control in Patients With Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction: Insights From Get With The Guidelines-Heart Failure.J Am Heart Assoc 8, no. 24 (December 17, 2019): e011560. https://doi.org/10.1161/JAHA.118.011560.
Kelly, Jacob P., et al. “Rhythm Control Versus Rate Control in Patients With Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction: Insights From Get With The Guidelines-Heart Failure.J Am Heart Assoc, vol. 8, no. 24, Dec. 2019, p. e011560. Pubmed, doi:10.1161/JAHA.118.011560.
Kelly JP, DeVore AD, Wu J, Hammill BG, Sharma A, Cooper LB, Felker GM, Piccini JP, Allen LA, Heidenreich PA, Peterson ED, Yancy CW, Fonarow GC, Hernandez AF. Rhythm Control Versus Rate Control in Patients With Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction: Insights From Get With The Guidelines-Heart Failure. J Am Heart Assoc. 2019 Dec 17;8(24):e011560.
Journal cover image

Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

December 17, 2019

Volume

8

Issue

24

Start / End Page

e011560

Location

England

Related Subject Headings

  • Stroke Volume
  • Retrospective Studies
  • Practice Guidelines as Topic
  • Male
  • Humans
  • Heart Rate
  • Heart Failure
  • Female
  • Atrial Fibrillation
  • Aged, 80 and over