Comparison of Rhythm and Rate Control Strategies for Stroke Occurrence in a Prospective Cohort of Atrial Fibrillation Patients
Yonsei Medical Journal
;
: 258-264, 2018.
Article
in English
| WPRIM
| ID: wpr-713095
ABSTRACT
PURPOSE:
Comparisons of rhythm and rate control strategies for stroke prevention in patients with atrial fibrillation (AF) are still inconclusive. We compared differences in clinical outcomes between the rhythm and rate control strategies. MATERIALS ANDMETHODS:
The COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) registry prospectively enrolled 6000 patients who were treated for AF using real-world guideline adherence at multiple referral centers. In total, 2508 (41.8%) patients were clinically followed up for over six months. Of these, 1134 (45.2 %) patients treated by rhythm control and 1374 (54.8 %) patients treated by rate control were analyzed for clinical outcomes, including stroke and cardiovascular outcomes.RESULTS:
Among all patients (age, 68±10 years; male, 62.4%), those treated with the rhythm control strategy were significantly younger, had more symptomatic paroxysmal AF, and a shorter AF duration, and were less likely to have diabetes, renal dysfunction, and heart failure, compared to those treated with the rate control strategy (CHA₂DS₂-VASc score 2.4±1.5 vs. 3.1±1.7, p < 0.001). Even though oral anticoagulation was similarly prescribed in both groups, occurrence of stroke was less likely to occur in the rhythm control strategy group (0.0% vs. 0.7%, p=0.015). Multivariate Cox hazard regression showed that only age, especially more than 75 years old, were significantly correlated with the occurrence of stroke, regardless of the strategy used for treatment.CONCLUSION:
In this prospective AF cohort, compared with the rate control strategy, the rhythm control strategy was associated with fewer cardiovascular events and strokes in a short-term period.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Atrial Fibrillation
/
Proportional Hazards Models
/
Antithrombins
/
Administration, Oral
/
Prospective Studies
/
Treatment Outcome
/
Stroke
/
Kaplan-Meier Estimate
/
Heart Rate
Type of study:
Practice guideline
/
Observational study
/
Prognostic study
Limits:
Aged
/
Female
/
Humans
/
Male
Language:
English
Journal:
Yonsei Medical Journal
Year:
2018
Type:
Article
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