Comparison of Rhythm and Rate Control Strategies for Stroke Occurrence in a Prospective Cohort of Atrial Fibrillation Patients
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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 and Methods: 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 multiplereferral 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.
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 and Methods: 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 multiplereferral 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.
참고문헌 (28)
- Bunch TJ, "Patients treated with catheter ablation for atrial fibrillation have long-term rates of death, stroke, and dementia similar to patients without atrial fibrillation", J Cardiovasc Electrophysiol, 22, pp.839~845 (2011)[DOI]
- Kirchhof P, "2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS", Eur Heart J, 37, pp.2893~2962 (2016)[DOI]
- January CT, "2014 AHA", ACC, American Heart Association Task Force on practice guidelines and the Heart Rhythm Society, pp.Circulation, 2014[DOI]
- Hart RG, "Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation", Ann Intern Med, 146, pp.857~867 (2007)[DOI]
- Freedman B, "Stroke prevention in atrial fibrillation", Lancet, 388, pp.806~817 (2016)[DOI]
- Ruff CT, "Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials", Lancet, 383, pp.955~962 (2014)[DOI]
- Rolf S, "What can rhythm control therapy contribute to prognosis in atrial fibrillation?", Heart, 101, pp.842~846 (2015)[DOI]
- Al-Khatib SM, "Rate- and rhythm-control therapies in patients with atrial fibrillation: a systematic review", Ann Intern Med, 160, pp.760~773 (2014)[DOI]
- Wyse DG, "A comparison of rate control and rhythm control in patients with atrial fibrillation", N Engl J Med, 347, pp.1825~1833 (2002)[DOI]
- Scheinman MM, "Atrial fibrillation therapy: rate versus rhythm control", Pacing Clin Electrophysiol, 26, pp.1175~1177 (2003)[DOI]
- Gillinov AM, "Rate control versus rhythm control for atrial fibrillation after cardiac surgery", N Engl J Med, 374, pp.1911~1921 (2016)[DOI]
- Tsadok MA, "Rhythm versus rate control therapy and subsequent stroke or transient ischemic attack in patients with atrial fibrillation", Circulation, 126, pp.2680~2687 (2012)[DOI]
- Bunch TJ, "Atrial fibrillation ablation patients have long-term stroke rates similar to patients without atrial fibrillation regardless of CHADS2 score", Heart Rhythm, 10, pp.1272~1277 (2013)[DOI]
- Stevens PE, "Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline", Ann Intern Med, 158, pp.825~830 (2013)[DOI]
- January CT, "2014 AHA", ACC, American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society, pp.J Am Coll Cardiol, 2014[DOI]
- Calkins H, "HRS", EHRA, Heart Rhythm, pp.2007, 4[DOI]
- 김형수, "A Prospective Survey of Atrial Fibrillation Management for Real-world Guideline Adherence: COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) Registry", Korean Circulation Journal, 47(6), pp.877~887 (2017), 대한심장학회[DOI]
- Schulman S, "Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients", J Thromb Haemost, 3, pp.692~694 (2005)[DOI]
- Kaatz S, "Definition of clinically relevant nonmajor bleeding in studies of anticoagulants in atrial fibrillation and venous thromboembolic disease in non-surgical patients: communication from the SSC of the ISTH", J Thromb Haemost, 13, pp.2119~2126 (2015)[DOI]
- Hohnloser SH, "Rhythm or rate control in atrial fibrillation--Pharmacological Intervention in Atrial Fibrillation (PIAF): a randomised trial", Lancet, 356, pp.1789~1794 (2000)[DOI]
- Hagens VE, "Rate control is more cost-effective than rhythm control for patients with persistent atrial fibrillation--results from the RAte Control versus Electrical cardioversion (RACE) study", Eur Heart J, 25, pp.1542~1549 (2004)[DOI]
- Chatterjee S, "Pharmacologic rate versus rhythm-control strategies in atrial fibrillation: an updated comprehensive review and meta-analysis", Pacing Clin Electrophysiol, 36, pp.122~133 (2013)[DOI]
- 신동금, "Cardiovascular Events of Electrical Cardioversion Under Optimal Anticoagulation in Atrial Fibrillation: The Multicenter Analysis", Yonsei Medical Journal, 56(6), pp.1552~1558 (2015), 연세대학교의과대학[DOI]
- Saliba W, "Catheter ablation of atrial fibrillation is associated with reduced risk of stroke and mortality: a propensity score-matched analysis", Heart Rhythm, 14, pp.635~642 (2017)[DOI]
- Camm AJ, "Real-life observations of clinical outcomes with rhythmand rate-control therapies for atrial fibrillation RECORDAF (Registry on Cardiac Rhythm Disorders Assessing the Control of Atrial Fibrillation)", J Am Coll Cardiol, 58, pp.493~501 (2011)[DOI]
- Sherman DG, "Stroke prevention in atrial fibrillation: pharmacological rate versus rhythm control", Stroke, 38(2 Suppl), pp.615~617 (2007)[DOI]
- Suzuki S, "Incidence of ischemic stroke in Japanese patients with atrial fibrillation not receiving anticoagulation therapy--pooled analysis of the Shinken Database, J-RHYTHM Registry, and Fushimi AF Registry", Circ J, 79, pp.432~438 (2015)[DOI]
- Steinberg BA, "Rate versus rhythm control for management of atrial fibrillation in clinical practice: results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry", Am Heart J, 165, pp.622~629 (2013)[DOI]