Cargando…

Anticoagulation, therapy of concomitant conditions, and early rhythm control therapy: a detailed analysis of treatment patterns in the EAST - AFNET 4 trial

AIMS: Treatment patterns were compared between randomized groups in EAST-AFNET 4 to assess whether differences in anticoagulation, therapy of concomitant diseases, or intensity of care can explain the clinical benefit achieved with early rhythm control in EAST-AFNET 4. METHODS AND RESULTS: Cardiovas...

Descripción completa

Detalles Bibliográficos
Autores principales: Metzner, Andreas, Suling, Anna, Brandes, Axel, Breithardt, , Günter, Camm, A John, Crijns, Harry J G M, Eckardt, , Lars, Elvan, , Arif, Goette, , Andreas, Haegeli, , Laurent M, Heidbuchel, , Hein, Kautzner, , Josef, Kuck, , Karl-Heinz, Mont, , Luis, Ng, G Andre, Szumowski, , Lukasz, Themistoclakis, , Sakis, van Gelder, , Isabelle C, Vardas, , Panos, Wegscheider, , Karl, Willems, , Stephan, Kirchhof, Paulus
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8982435/
https://www.ncbi.nlm.nih.gov/pubmed/34473249
http://dx.doi.org/10.1093/europace/euab200
_version_ 1784681811145654272
author Metzner, Andreas
Suling, Anna
Brandes, Axel
Breithardt, , Günter
Camm, A John
Crijns, Harry J G M
Eckardt, , Lars
Elvan, , Arif
Goette, , Andreas
Haegeli, , Laurent M
Heidbuchel, , Hein
Kautzner, , Josef
Kuck, , Karl-Heinz
Mont, , Luis
Ng, G Andre
Szumowski, , Lukasz
Themistoclakis, , Sakis
van Gelder, , Isabelle C
Vardas, , Panos
Wegscheider, , Karl
Willems, , Stephan
Kirchhof, Paulus
author_facet Metzner, Andreas
Suling, Anna
Brandes, Axel
Breithardt, , Günter
Camm, A John
Crijns, Harry J G M
Eckardt, , Lars
Elvan, , Arif
Goette, , Andreas
Haegeli, , Laurent M
Heidbuchel, , Hein
Kautzner, , Josef
Kuck, , Karl-Heinz
Mont, , Luis
Ng, G Andre
Szumowski, , Lukasz
Themistoclakis, , Sakis
van Gelder, , Isabelle C
Vardas, , Panos
Wegscheider, , Karl
Willems, , Stephan
Kirchhof, Paulus
author_sort Metzner, Andreas
collection PubMed
description AIMS: Treatment patterns were compared between randomized groups in EAST-AFNET 4 to assess whether differences in anticoagulation, therapy of concomitant diseases, or intensity of care can explain the clinical benefit achieved with early rhythm control in EAST-AFNET 4. METHODS AND RESULTS: Cardiovascular treatment patterns and number of visits were compared between randomized groups in EAST-AFNET 4. Oral anticoagulation was used in >90% of patients during follow-up without differences between randomized groups. There were no differences in treatment of concomitant conditions between groups. The type of rhythm control varied by country and centre. Over time, antiarrhythmic drugs were given to 1171/1395 (84%) patients in early therapy, and to 202/1394 (14%) in usual care. Atrial fibrillation (AF) ablation was performed in 340/1395 (24%) patients randomized to early therapy, and in 168/1394 (12%) patients randomized to usual care. 97% of rhythm control therapies were within class I and class III recommendations of AF guidelines. Patients randomized to early therapy transmitted 297 166 telemetric electrocardiograms (ECGs) to a core lab. In total, 97 978 abnormal ECGs were sent to study sites. The resulting difference between study visits was low (0.06 visits/patient/year), with slightly more visits in early therapy (usual care 0.39 visits/patient/year; early rhythm control 0.45 visits/patient/year, P < 0.001), mainly due to visits for symptomatic AF recurrences or recurrent AF on telemetric ECGs. CONCLUSION: The clinical benefit of early, systematic rhythm control therapy was achieved using variable treatment patterns of antiarrhythmic drugs and AF ablation, applied within guideline recommendations.
format Online
Article
Text
id pubmed-8982435
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-89824352022-04-05 Anticoagulation, therapy of concomitant conditions, and early rhythm control therapy: a detailed analysis of treatment patterns in the EAST - AFNET 4 trial Metzner, Andreas Suling, Anna Brandes, Axel Breithardt, , Günter Camm, A John Crijns, Harry J G M Eckardt, , Lars Elvan, , Arif Goette, , Andreas Haegeli, , Laurent M Heidbuchel, , Hein Kautzner, , Josef Kuck, , Karl-Heinz Mont, , Luis Ng, G Andre Szumowski, , Lukasz Themistoclakis, , Sakis van Gelder, , Isabelle C Vardas, , Panos Wegscheider, , Karl Willems, , Stephan Kirchhof, Paulus Europace Clinical Research AIMS: Treatment patterns were compared between randomized groups in EAST-AFNET 4 to assess whether differences in anticoagulation, therapy of concomitant diseases, or intensity of care can explain the clinical benefit achieved with early rhythm control in EAST-AFNET 4. METHODS AND RESULTS: Cardiovascular treatment patterns and number of visits were compared between randomized groups in EAST-AFNET 4. Oral anticoagulation was used in >90% of patients during follow-up without differences between randomized groups. There were no differences in treatment of concomitant conditions between groups. The type of rhythm control varied by country and centre. Over time, antiarrhythmic drugs were given to 1171/1395 (84%) patients in early therapy, and to 202/1394 (14%) in usual care. Atrial fibrillation (AF) ablation was performed in 340/1395 (24%) patients randomized to early therapy, and in 168/1394 (12%) patients randomized to usual care. 97% of rhythm control therapies were within class I and class III recommendations of AF guidelines. Patients randomized to early therapy transmitted 297 166 telemetric electrocardiograms (ECGs) to a core lab. In total, 97 978 abnormal ECGs were sent to study sites. The resulting difference between study visits was low (0.06 visits/patient/year), with slightly more visits in early therapy (usual care 0.39 visits/patient/year; early rhythm control 0.45 visits/patient/year, P < 0.001), mainly due to visits for symptomatic AF recurrences or recurrent AF on telemetric ECGs. CONCLUSION: The clinical benefit of early, systematic rhythm control therapy was achieved using variable treatment patterns of antiarrhythmic drugs and AF ablation, applied within guideline recommendations. Oxford University Press 2021-09-02 /pmc/articles/PMC8982435/ /pubmed/34473249 http://dx.doi.org/10.1093/europace/euab200 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Research
Metzner, Andreas
Suling, Anna
Brandes, Axel
Breithardt, , Günter
Camm, A John
Crijns, Harry J G M
Eckardt, , Lars
Elvan, , Arif
Goette, , Andreas
Haegeli, , Laurent M
Heidbuchel, , Hein
Kautzner, , Josef
Kuck, , Karl-Heinz
Mont, , Luis
Ng, G Andre
Szumowski, , Lukasz
Themistoclakis, , Sakis
van Gelder, , Isabelle C
Vardas, , Panos
Wegscheider, , Karl
Willems, , Stephan
Kirchhof, Paulus
Anticoagulation, therapy of concomitant conditions, and early rhythm control therapy: a detailed analysis of treatment patterns in the EAST - AFNET 4 trial
title Anticoagulation, therapy of concomitant conditions, and early rhythm control therapy: a detailed analysis of treatment patterns in the EAST - AFNET 4 trial
title_full Anticoagulation, therapy of concomitant conditions, and early rhythm control therapy: a detailed analysis of treatment patterns in the EAST - AFNET 4 trial
title_fullStr Anticoagulation, therapy of concomitant conditions, and early rhythm control therapy: a detailed analysis of treatment patterns in the EAST - AFNET 4 trial
title_full_unstemmed Anticoagulation, therapy of concomitant conditions, and early rhythm control therapy: a detailed analysis of treatment patterns in the EAST - AFNET 4 trial
title_short Anticoagulation, therapy of concomitant conditions, and early rhythm control therapy: a detailed analysis of treatment patterns in the EAST - AFNET 4 trial
title_sort anticoagulation, therapy of concomitant conditions, and early rhythm control therapy: a detailed analysis of treatment patterns in the east - afnet 4 trial
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8982435/
https://www.ncbi.nlm.nih.gov/pubmed/34473249
http://dx.doi.org/10.1093/europace/euab200
work_keys_str_mv AT metznerandreas anticoagulationtherapyofconcomitantconditionsandearlyrhythmcontroltherapyadetailedanalysisoftreatmentpatternsintheeastafnet4trial
AT sulinganna anticoagulationtherapyofconcomitantconditionsandearlyrhythmcontroltherapyadetailedanalysisoftreatmentpatternsintheeastafnet4trial
AT brandesaxel anticoagulationtherapyofconcomitantconditionsandearlyrhythmcontroltherapyadetailedanalysisoftreatmentpatternsintheeastafnet4trial
AT breithardtgunter anticoagulationtherapyofconcomitantconditionsandearlyrhythmcontroltherapyadetailedanalysisoftreatmentpatternsintheeastafnet4trial
AT cammajohn anticoagulationtherapyofconcomitantconditionsandearlyrhythmcontroltherapyadetailedanalysisoftreatmentpatternsintheeastafnet4trial
AT crijnsharryjgm anticoagulationtherapyofconcomitantconditionsandearlyrhythmcontroltherapyadetailedanalysisoftreatmentpatternsintheeastafnet4trial
AT eckardtlars anticoagulationtherapyofconcomitantconditionsandearlyrhythmcontroltherapyadetailedanalysisoftreatmentpatternsintheeastafnet4trial
AT elvanarif anticoagulationtherapyofconcomitantconditionsandearlyrhythmcontroltherapyadetailedanalysisoftreatmentpatternsintheeastafnet4trial
AT goetteandreas anticoagulationtherapyofconcomitantconditionsandearlyrhythmcontroltherapyadetailedanalysisoftreatmentpatternsintheeastafnet4trial
AT haegelilaurentm anticoagulationtherapyofconcomitantconditionsandearlyrhythmcontroltherapyadetailedanalysisoftreatmentpatternsintheeastafnet4trial
AT heidbuchelhein anticoagulationtherapyofconcomitantconditionsandearlyrhythmcontroltherapyadetailedanalysisoftreatmentpatternsintheeastafnet4trial
AT kautznerjosef anticoagulationtherapyofconcomitantconditionsandearlyrhythmcontroltherapyadetailedanalysisoftreatmentpatternsintheeastafnet4trial
AT kuckkarlheinz anticoagulationtherapyofconcomitantconditionsandearlyrhythmcontroltherapyadetailedanalysisoftreatmentpatternsintheeastafnet4trial
AT montluis anticoagulationtherapyofconcomitantconditionsandearlyrhythmcontroltherapyadetailedanalysisoftreatmentpatternsintheeastafnet4trial
AT nggandre anticoagulationtherapyofconcomitantconditionsandearlyrhythmcontroltherapyadetailedanalysisoftreatmentpatternsintheeastafnet4trial
AT szumowskilukasz anticoagulationtherapyofconcomitantconditionsandearlyrhythmcontroltherapyadetailedanalysisoftreatmentpatternsintheeastafnet4trial
AT themistoclakissakis anticoagulationtherapyofconcomitantconditionsandearlyrhythmcontroltherapyadetailedanalysisoftreatmentpatternsintheeastafnet4trial
AT vangelderisabellec anticoagulationtherapyofconcomitantconditionsandearlyrhythmcontroltherapyadetailedanalysisoftreatmentpatternsintheeastafnet4trial
AT vardaspanos anticoagulationtherapyofconcomitantconditionsandearlyrhythmcontroltherapyadetailedanalysisoftreatmentpatternsintheeastafnet4trial
AT wegscheiderkarl anticoagulationtherapyofconcomitantconditionsandearlyrhythmcontroltherapyadetailedanalysisoftreatmentpatternsintheeastafnet4trial
AT willemsstephan anticoagulationtherapyofconcomitantconditionsandearlyrhythmcontroltherapyadetailedanalysisoftreatmentpatternsintheeastafnet4trial
AT kirchhofpaulus anticoagulationtherapyofconcomitantconditionsandearlyrhythmcontroltherapyadetailedanalysisoftreatmentpatternsintheeastafnet4trial