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Rhythm versus rate control in the contemporary management of atrial fibrillation in-hospital.

Publication ,  Journal Article
Allen Lapointe, NM; Sun, J-L; Kaplan, S; d'Almada, P; Al-Khatib, SM
Published in: Am J Cardiol
April 15, 2008

Little is presently known regarding whether a rhythm-control or a rate-control strategy is more frequently used in patients hospitalized for atrial fibrillation (AF). This study was conducted to assess patient and physician characteristics associated with each treatment strategy and with the use of anticoagulants. Hospitalizations for primary diagnoses of AF were examined using hospital claims from January 2000 to December 2004. Patients who received antiarrhythmic drugs, ablation, or cardioversion for AF were categorized as receiving rhythm control. Patients managed only with beta blockers, calcium channel blockers, or digoxin were categorized as receiving rate control. Characteristics associated with rhythm compared with rate control and anticoagulant use with CHADS(2) score were determined. The study cohort included 155,731 hospitalizations from 464 hospitals. Of these, 75,397 (48%) were categorized as involving rhythm control and 80,334 (52%) as involving rate control. Care by a noncardiologist (adjusted odds ratio [OR] 0.33, 95% confidence interval [CI] 0.31 to 0.36) and increasing age >65 years (adjusted OR 0.87, 95% CI 0.86 to 0.88) were associated with lower odds of rhythm versus rate control; hypertrophic cardiomyopathy was associated with greater odds (adjusted OR 2.3, 95% CI 1.81 to 2.84) of rhythm control. Warfarin use was greater in the rhythm-control group compared with the rate-control group (adjusted OR 1.56, 95% CI 1.52 to 1.60), and warfarin use was greater with a CHADS(2) score > or =2 (unadjusted OR 1.21, 95% CI 1.19 to 1.24). In conclusion, rhythm- and rate-control strategies were used equally in patients hospitalized for AF. Some observations, such as greater use of the rate-control strategy with increasing age, were consistent with recommendations, but others, such as lower use of warfarin in the rate-control group, were not.

Duke Scholars

Published In

Am J Cardiol

DOI

ISSN

0002-9149

Publication Date

April 15, 2008

Volume

101

Issue

8

Start / End Page

1134 / 1141

Location

United States

Related Subject Headings

  • Wolff-Parkinson-White Syndrome
  • Warfarin
  • United States
  • Specialization
  • Severity of Illness Index
  • Retrospective Studies
  • Platelet Aggregation Inhibitors
  • Myocardial Infarction
  • Middle Aged
  • Medicine
 

Citation

APA
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ICMJE
MLA
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Allen Lapointe, N. M., Sun, J.-L., Kaplan, S., d’Almada, P., & Al-Khatib, S. M. (2008). Rhythm versus rate control in the contemporary management of atrial fibrillation in-hospital. Am J Cardiol, 101(8), 1134–1141. https://doi.org/10.1016/j.amjcard.2007.11.067
Allen Lapointe, Nancy M., Jie-Lena Sun, Sigal Kaplan, Phil d’Almada, and Sana M. Al-Khatib. “Rhythm versus rate control in the contemporary management of atrial fibrillation in-hospital.Am J Cardiol 101, no. 8 (April 15, 2008): 1134–41. https://doi.org/10.1016/j.amjcard.2007.11.067.
Allen Lapointe NM, Sun J-L, Kaplan S, d’Almada P, Al-Khatib SM. Rhythm versus rate control in the contemporary management of atrial fibrillation in-hospital. Am J Cardiol. 2008 Apr 15;101(8):1134–41.
Allen Lapointe, Nancy M., et al. “Rhythm versus rate control in the contemporary management of atrial fibrillation in-hospital.Am J Cardiol, vol. 101, no. 8, Apr. 2008, pp. 1134–41. Pubmed, doi:10.1016/j.amjcard.2007.11.067.
Allen Lapointe NM, Sun J-L, Kaplan S, d’Almada P, Al-Khatib SM. Rhythm versus rate control in the contemporary management of atrial fibrillation in-hospital. Am J Cardiol. 2008 Apr 15;101(8):1134–1141.
Journal cover image

Published In

Am J Cardiol

DOI

ISSN

0002-9149

Publication Date

April 15, 2008

Volume

101

Issue

8

Start / End Page

1134 / 1141

Location

United States

Related Subject Headings

  • Wolff-Parkinson-White Syndrome
  • Warfarin
  • United States
  • Specialization
  • Severity of Illness Index
  • Retrospective Studies
  • Platelet Aggregation Inhibitors
  • Myocardial Infarction
  • Middle Aged
  • Medicine