Routine vs. Aggressive upstream rhythm Control for prevention of Early persistent atrial fibrillation in heart failure study - RACE 3

Contribution To Literature:

The RACE 3 trial showed that upstream risk factor modification was superior at maintaining sinus rhythm.

Description:

The goal of the trial was to evaluate upstream risk factor modification compared with conventional therapy among patients with early persistent atrial fibrillation.

Study Design

  • Randomized
  • Parallel

Patients with early persistent atrial fibrillation and heart failure were randomized to upstream therapy (n = 119) versus conventional therapy (n = 126).

Upstream therapy consisted of mineralocorticoid receptor antagonist, statin, angiotensin-converting enzyme (ACE) inhibitor and/or angiotensin receptor blocker, and cardiac rehabilitation.

Inclusion criteria:

  • Early persistent atrial fibrillation and mild to moderate heart failure
  • Total number of enrollees: 245
  • Duration of follow-up: 1 year

Principal Findings:

The primary outcome, incidence of sinus rhythm at 1 year, occurred in 75% of the upstream therapy group versus 63% of the conventional therapy group (p = 0.021).

Interpretation:

Among patients with early persistent atrial fibrillation, upstream risk factor modification was effective at maintaining sinus rhythm at 1 year. Use of mineralocorticoid receptor antagonists, statins, ACE inhibitor and/or angiotensin receptor blockers, and cardiac rehabilitation can be considered in patients with persistent atrial fibrillation.

References:

Presented by Dr. Michiel Rienstra at the European Society of Cardiology Congress, Barcelona, Spain, August 27, 2017.


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