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Analysis of cause-specific mortality in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study.

Publication ,  Journal Article
Steinberg, JS; Sadaniantz, A; Kron, J; Krahn, A; Denny, DM; Daubert, J; Campbell, WB; Havranek, E; Murray, K; Olshansky, B; O'Neill, G ...
Published in: Circulation
April 27, 2004

BACKGROUND: Expectations that reestablishing and maintaining sinus rhythm in patients with atrial fibrillation might improve survival were disproved in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. This report describes the cause-specific modes of death in the AFFIRM treatment groups. METHODS AND RESULTS: All deaths in patients enrolled in AFFIRM underwent blinded review by the AFFIRM Events Committee, and a mode of death was assigned. In AFFIRM, 2033 patients were randomized to a rhythm-control strategy and 2027 patients to a rate-control strategy. During a mean follow-up of 3.5 years, there were 356 deaths in the rhythm-control patients and 310 deaths in the rate-control patients (P=0.07). In the rhythm-control group, 129 patients (9%) died of a cardiac cause, and in the rate-control group, 130 patients (10%) died (P=0.95). Both groups had similar rates of arrhythmic and nonarrhythmic cardiac deaths. The numbers of vascular deaths were similar in the 2 groups: 35 (3%) in the rhythm-control group and 37 (3%) in the rate-control group (P=0.82). There were no differences in the rates of ischemic stroke and central nervous system hemorrhage. In the rhythm-control group, there were 169 noncardiovascular deaths (47.5% of the total number of deaths), whereas in the rate-control arm, there were 113 noncardiovascular deaths (36.5% of the total number of deaths) (P=0.0008). Differences in noncardiovascular death rates were due to pulmonary and cancer-related deaths. CONCLUSIONS: Management of atrial fibrillation with a rhythm-control strategy conferred no advantage over a rate-control strategy in cardiac or vascular mortality and may be associated with an increased noncardiovascular death rate.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

April 27, 2004

Volume

109

Issue

16

Start / End Page

1973 / 1980

Location

United States

Related Subject Headings

  • Survival Analysis
  • Proportional Hazards Models
  • Humans
  • Follow-Up Studies
  • Cardiovascular System & Hematology
  • Atrial Fibrillation
  • Anti-Arrhythmia Agents
  • Aged
  • 4207 Sports science and exercise
  • 3202 Clinical sciences
 

Citation

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Steinberg, J. S., Sadaniantz, A., Kron, J., Krahn, A., Denny, D. M., Daubert, J., … Greene, H. L. (2004). Analysis of cause-specific mortality in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Circulation, 109(16), 1973–1980. https://doi.org/10.1161/01.CIR.0000118472.77237.FA
Steinberg, Jonathan S., Ara Sadaniantz, Jack Kron, Andrew Krahn, D Marty Denny, James Daubert, W Barton Campbell, et al. “Analysis of cause-specific mortality in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study.Circulation 109, no. 16 (April 27, 2004): 1973–80. https://doi.org/10.1161/01.CIR.0000118472.77237.FA.
Steinberg JS, Sadaniantz A, Kron J, Krahn A, Denny DM, Daubert J, et al. Analysis of cause-specific mortality in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Circulation. 2004 Apr 27;109(16):1973–80.
Steinberg, Jonathan S., et al. “Analysis of cause-specific mortality in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study.Circulation, vol. 109, no. 16, Apr. 2004, pp. 1973–80. Pubmed, doi:10.1161/01.CIR.0000118472.77237.FA.
Steinberg JS, Sadaniantz A, Kron J, Krahn A, Denny DM, Daubert J, Campbell WB, Havranek E, Murray K, Olshansky B, O’Neill G, Sami M, Schmidt S, Storm R, Zabalgoitia M, Miller J, Chandler M, Nasco EM, Greene HL. Analysis of cause-specific mortality in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Circulation. 2004 Apr 27;109(16):1973–1980.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

April 27, 2004

Volume

109

Issue

16

Start / End Page

1973 / 1980

Location

United States

Related Subject Headings

  • Survival Analysis
  • Proportional Hazards Models
  • Humans
  • Follow-Up Studies
  • Cardiovascular System & Hematology
  • Atrial Fibrillation
  • Anti-Arrhythmia Agents
  • Aged
  • 4207 Sports science and exercise
  • 3202 Clinical sciences