Patterns of care for first-detected atrial fibrillation: Insights from the Get With The Guidelines® - Atrial Fibrillation registry.

Journal Article (Journal Article)

BACKGROUND: Despite multiple trials comparing rate with rhythm control, there is no consensus on the optimal management of first-detected atrial fibrillation (AF). OBJECTIVE: We analyzed current patterns of care for first-detected AF in the nationwide Get With The Guidelines® - Atrial Fibrillation registry. METHODS: Patients hospitalized with first-detected AF from 2013 to 2019 were included, and a descriptive analysis was performed comparing planned rate with rhythm control. Multivariable logistic regression analysis was performed to identify predictors for choosing rhythm over rate control. RESULTS: Of the 86,759 patients with AF, 17.8% (15,473) had first-detected AF; 11,685 patients were included from 126 sites. Overall, 51.3% (5999) of patients were treated with rate control and 48.7% (5686) with rhythm control at admission. Patients with planned rhythm control had a shorter length of stay and were more likely to be discharged home than a facility. A higher percentage of patients with planned rhythm control were discharged on anticoagulation than those with planned rate control (75.6% vs 70.9%) despite a higher underlying stroke risk in the rate control group (higher median CHA2DS2-VASc score 4; Q1-Q3 2-5 for rate control vs 3; Q1-Q3 2-4 for rhyhtm control; P < .001). While Hispanic ethnicity, Medicaid insurance, age >70 years, and liver disease decreased the likelihood of rhythm control, factors such as heart failure, stroke, or prior bleeding diathesis had no association with the chosen treatment strategy. CONCLUSION: Less than half of the patients with first-detected AF receive rhythm control at admission. Given recent trial results, further studies should assess the long-term impact of rhythm control on patients' symptoms and quality of life, cardiovascular morbidity, and mortality.

Full Text

Duke Authors

Cited Authors

  • Kir, D; Zhang, S; Kaltenbach, LA; Fonarow, GC; Matsouaka, RA; Piccini, JP; Desai, NR

Published Date

  • July 2022

Published In

Volume / Issue

  • 19 / 7

Start / End Page

  • 1049 - 1057

PubMed ID

  • 35247626

Electronic International Standard Serial Number (EISSN)

  • 1556-3871

Digital Object Identifier (DOI)

  • 10.1016/j.hrthm.2022.02.025


  • eng

Conference Location

  • United States