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Rate versus rhythm control and outcomes in patients with atrial fibrillation and chronic kidney disease: data from the GUSTO-III Trial.

Publication ,  Journal Article
Williams, ES; Thompson, VP; Chiswell, KE; Alexander, JH; White, HD; Ohman, EM; Al-Khatib, SM
Published in: Cardiol J
2013

BACKGROUND: Atrial fibrillation (AF) and chronic kidney disease (CKD) have both been shown to portend worse outcomes after acute myocardial infarction (MI); however, the benefit of a rhythm control strategy in patients with CKD post-MI is unclear. METHODS: We prospectively studied 985 patients with new-onset AF post-MI in the GUSTO-III trial, of whom 413 (42%) had CKD (creatinine clearance < 60 mL/min). A rhythm control strategy, defined as the use of an antiarrhythmic medication and/or electrical cardioversion, was used in 346 (35%) of patients. RESULTS: A rhythm control strategy was used in 34% of patients with CKD and 36% of patients with no CKD. At hospital discharge, sinus rhythm was present in 487 (76%) of patients treated with a rate control strategy, vs. 276 (80%) in those treated with rhythm control (p = 0.20). CKD was associated with a lower odds of sinus rhythm at discharge (unadjusted OR 0.56, 95% CI 0.38-0.84, p < 0.001). However, in multivariable analyses, treatment with a rhythm control strategy was not associated with discharge rhythm (HR 1.068, 95% CI 0.69-1.66, p = 0.77), 30-day mortality (HR 0.78, 95% CI 0.54-1.12, p = 0.18) or mortality from day 30 to 1 year (HR 1.00, 95% CI 0.59-1.69, p = 0.99). CKD status did not significantly impact the relationship between rhythm control and outcomes. CONCLUSIONS: Treatment with a rhythm or rate control strategy does not signifi cantly impact short-term or long-term mortality in patients with post-MI AF, regardless of kidney disease status. Future studies to investigate the optimal management of AF in CKD patients are needed.

Duke Scholars

Published In

Cardiol J

DOI

EISSN

1898-018X

Publication Date

2013

Volume

20

Issue

4

Start / End Page

439 / 446

Location

Poland

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Renal Insufficiency, Chronic
  • Prospective Studies
  • Proportional Hazards Models
  • Patient Discharge
  • Odds Ratio
  • Myocardial Infarction
  • Multivariate Analysis
 

Citation

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MLA
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Williams, E. S., Thompson, V. P., Chiswell, K. E., Alexander, J. H., White, H. D., Ohman, E. M., & Al-Khatib, S. M. (2013). Rate versus rhythm control and outcomes in patients with atrial fibrillation and chronic kidney disease: data from the GUSTO-III Trial. Cardiol J, 20(4), 439–446. https://doi.org/10.5603/CJ.2013.0104
Williams, Eric S., Vivian P. Thompson, Karen E. Chiswell, John H. Alexander, Harvey D. White, E Magnus Ohman, and Sana M. Al-Khatib. “Rate versus rhythm control and outcomes in patients with atrial fibrillation and chronic kidney disease: data from the GUSTO-III Trial.Cardiol J 20, no. 4 (2013): 439–46. https://doi.org/10.5603/CJ.2013.0104.
Williams ES, Thompson VP, Chiswell KE, Alexander JH, White HD, Ohman EM, et al. Rate versus rhythm control and outcomes in patients with atrial fibrillation and chronic kidney disease: data from the GUSTO-III Trial. Cardiol J. 2013;20(4):439–46.
Williams, Eric S., et al. “Rate versus rhythm control and outcomes in patients with atrial fibrillation and chronic kidney disease: data from the GUSTO-III Trial.Cardiol J, vol. 20, no. 4, 2013, pp. 439–46. Pubmed, doi:10.5603/CJ.2013.0104.
Williams ES, Thompson VP, Chiswell KE, Alexander JH, White HD, Ohman EM, Al-Khatib SM. Rate versus rhythm control and outcomes in patients with atrial fibrillation and chronic kidney disease: data from the GUSTO-III Trial. Cardiol J. 2013;20(4):439–446.

Published In

Cardiol J

DOI

EISSN

1898-018X

Publication Date

2013

Volume

20

Issue

4

Start / End Page

439 / 446

Location

Poland

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Renal Insufficiency, Chronic
  • Prospective Studies
  • Proportional Hazards Models
  • Patient Discharge
  • Odds Ratio
  • Myocardial Infarction
  • Multivariate Analysis