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 YH 
ORCID: 0000-0002-7566-1626 et al (show 1 more authors)
(2021)
Treatment timing and the effects of rhythm control strategy in patients with atrial fibrillation: nationwide cohort study.
BMJ-BRITISH MEDICAL JOURNAL, 373.
n991-.
Abstract
<h4>Objective</h4>To investigate whether the results of a rhythm control strategy differ according to the duration between diagnosis of atrial fibrillation and treatment initiation.<h4>Design</h4>Longitudinal observational cohort study.<h4>Setting</h4>Population based cohort from the Korean National Health Insurance Service database.<h4>Participants</h4>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.<h4>Main outcome measure</h4>A composite outcome of death from cardiovascular causes, ischaemic stroke, admission to hospital for heart failure, or acute myocardial infarction.<h4>Results</h4>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 <i>v</i> 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 <i>v</i> 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.<h4>Conclusions</h4>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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Humans, Atrial Fibrillation, Myocardial Infarction, Anti-Arrhythmia Agents, Catheter Ablation, Hospitalization, Incidence, Retrospective Studies, Longitudinal Studies, Heart Rate, Databases, Factual, Aged, Middle Aged, Female, Male, Heart Failure, Republic of Korea, Time-to-Treatment, Ischemic Stroke |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 09 Oct 2023 13:59 |
| Last Modified: | 09 Oct 2023 13:59 |
| DOI: | 10.1136/bmj.n991 |
| Open Access URL: | https://doi.org/10.1136/bmj.n991 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3173559 |
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