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Treatment timing and the effects of rhythm control strategy in patients with atrial fibrillation: nationwide cohort study

OBJECTIVE: To investigate whether the results of a rhythm control strategy differ according to the duration between diagnosis of atrial fibrillation and treatment initiation. DESIGN: Longitudinal observational cohort study. SETTING: Population based cohort from the Korean National Health Insurance S...

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Autores principales: Kim, Daehoon, Yang, Pil-Sung, You, Seng Chan, Sung, Jung-Hoon, Jang, Eunsun, Yu, Hee Tae, Kim, Tae-Hoon, Pak, Hui-Nam, Lee, Moon-Hyoung, Lip, Gregory Y H, Joung, Boyoung
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group Ltd. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8111568/
https://www.ncbi.nlm.nih.gov/pubmed/33975876
http://dx.doi.org/10.1136/bmj.n991
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author Kim, Daehoon
Yang, Pil-Sung
You, Seng Chan
Sung, Jung-Hoon
Jang, Eunsun
Yu, Hee Tae
Kim, Tae-Hoon
Pak, Hui-Nam
Lee, Moon-Hyoung
Lip, Gregory Y H
Joung, Boyoung
author_facet Kim, Daehoon
Yang, Pil-Sung
You, Seng Chan
Sung, Jung-Hoon
Jang, Eunsun
Yu, Hee Tae
Kim, Tae-Hoon
Pak, Hui-Nam
Lee, Moon-Hyoung
Lip, Gregory Y H
Joung, Boyoung
author_sort Kim, Daehoon
collection PubMed
description OBJECTIVE: To investigate whether the results of a rhythm control strategy differ according to the duration between diagnosis of atrial fibrillation and treatment initiation. DESIGN: Longitudinal observational cohort study. SETTING: Population based cohort from the Korean National Health Insurance Service database. PARTICIPANTS: 22 635 adults with atrial fibrillation and cardiovascular conditions, newly treated with rhythm control (antiarrhythmic drugs or ablation) or rate control strategies between 28 July 2011 and 31 December 2015. MAIN OUTCOME MEASURE: A composite outcome of death from cardiovascular causes, ischaemic stroke, admission to hospital for heart failure, or acute myocardial infarction. RESULTS: Of the study population, 12 200 (53.9%) were male, the median age was 70, and the median follow-up duration was 2.1 years. Among patients with early treatment for atrial fibrillation (initiated within one year since diagnosis), compared with rate control, rhythm control was associated with a lower risk of the primary composite outcome (weighted incidence rate per 100 person years 7.42 in rhythm control v 9.25 in rate control; hazard ratio 0.81, 95% confidence interval 0.71 to 0.93; P=0.002). No difference in the risk of the primary composite outcome was found between rhythm and rate control (weighted incidence rate per 100 person years 8.67 in rhythm control v 8.99 in rate control; 0.97, 0.78 to 1.20; P=0.76) in patients with late treatment for atrial fibrillation (initiated after one year since diagnosis). No significant differences in safety outcomes were found between the rhythm and rate control strategies across different treatment timings. Earlier initiation of treatment was linearly associated with more favourable cardiovascular outcomes for rhythm control compared with rate control. CONCLUSIONS: Early initiation of rhythm control treatment was associated with a lower risk of adverse cardiovascular outcomes than rate control treatment in patients with recently diagnosed atrial fibrillation. This association was not found in patients who had had atrial fibrillation for more than one year.
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spelling pubmed-81115682021-05-25 Treatment timing and the effects of rhythm control strategy in patients with atrial fibrillation: nationwide cohort study Kim, Daehoon Yang, Pil-Sung You, Seng Chan Sung, Jung-Hoon Jang, Eunsun Yu, Hee Tae Kim, Tae-Hoon Pak, Hui-Nam Lee, Moon-Hyoung Lip, Gregory Y H Joung, Boyoung BMJ Research OBJECTIVE: To investigate whether the results of a rhythm control strategy differ according to the duration between diagnosis of atrial fibrillation and treatment initiation. DESIGN: Longitudinal observational cohort study. SETTING: Population based cohort from the Korean National Health Insurance Service database. PARTICIPANTS: 22 635 adults with atrial fibrillation and cardiovascular conditions, newly treated with rhythm control (antiarrhythmic drugs or ablation) or rate control strategies between 28 July 2011 and 31 December 2015. MAIN OUTCOME MEASURE: A composite outcome of death from cardiovascular causes, ischaemic stroke, admission to hospital for heart failure, or acute myocardial infarction. RESULTS: Of the study population, 12 200 (53.9%) were male, the median age was 70, and the median follow-up duration was 2.1 years. Among patients with early treatment for atrial fibrillation (initiated within one year since diagnosis), compared with rate control, rhythm control was associated with a lower risk of the primary composite outcome (weighted incidence rate per 100 person years 7.42 in rhythm control v 9.25 in rate control; hazard ratio 0.81, 95% confidence interval 0.71 to 0.93; P=0.002). No difference in the risk of the primary composite outcome was found between rhythm and rate control (weighted incidence rate per 100 person years 8.67 in rhythm control v 8.99 in rate control; 0.97, 0.78 to 1.20; P=0.76) in patients with late treatment for atrial fibrillation (initiated after one year since diagnosis). No significant differences in safety outcomes were found between the rhythm and rate control strategies across different treatment timings. Earlier initiation of treatment was linearly associated with more favourable cardiovascular outcomes for rhythm control compared with rate control. CONCLUSIONS: Early initiation of rhythm control treatment was associated with a lower risk of adverse cardiovascular outcomes than rate control treatment in patients with recently diagnosed atrial fibrillation. This association was not found in patients who had had atrial fibrillation for more than one year. BMJ Publishing Group Ltd. 2021-05-11 /pmc/articles/PMC8111568/ /pubmed/33975876 http://dx.doi.org/10.1136/bmj.n991 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Research
Kim, Daehoon
Yang, Pil-Sung
You, Seng Chan
Sung, Jung-Hoon
Jang, Eunsun
Yu, Hee Tae
Kim, Tae-Hoon
Pak, Hui-Nam
Lee, Moon-Hyoung
Lip, Gregory Y H
Joung, Boyoung
Treatment timing and the effects of rhythm control strategy in patients with atrial fibrillation: nationwide cohort study
title Treatment timing and the effects of rhythm control strategy in patients with atrial fibrillation: nationwide cohort study
title_full Treatment timing and the effects of rhythm control strategy in patients with atrial fibrillation: nationwide cohort study
title_fullStr Treatment timing and the effects of rhythm control strategy in patients with atrial fibrillation: nationwide cohort study
title_full_unstemmed Treatment timing and the effects of rhythm control strategy in patients with atrial fibrillation: nationwide cohort study
title_short Treatment timing and the effects of rhythm control strategy in patients with atrial fibrillation: nationwide cohort study
title_sort treatment timing and the effects of rhythm control strategy in patients with atrial fibrillation: nationwide cohort study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8111568/
https://www.ncbi.nlm.nih.gov/pubmed/33975876
http://dx.doi.org/10.1136/bmj.n991
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