Rate-Control Treatment and Mortality in Atrial Fibrillation

Study Questions:

Do rate-control medications affect survival in patients with atrial fibrillation (AF)?

Methods:

A national health database in Taiwan was used to gather the data for this study. A total of 354,649 patients with AF were identified. The patients were divided into groups depending on the type of rate-control drug that was prescribed: beta-blocker (n = 43,879); calcium channel blocker (n = 18,466); digoxin (n = 38,898); or no rate-control drug (n = 168,678). Patients receiving ≥1 type of rate-control drug were excluded. The primary endpoint was all-cause mortality. Comparisons between groups were performed using a propensity score-matched analysis.

Results:

The mortality rate at a mean follow-up of 4.9 years was 32%. After adjustment for confounding variables, the hazard ratio for mortality compared to the patients not receiving a rate-control drug was 0.76 for beta-blockers, 0.93 for calcium channel blockers, and 1.12 for digoxin.

Conclusions:

The authors concluded that beta-blockers and calcium channel blockers are associated with a lower risk of death among patients with AF, whereas digoxin is associated with a higher risk of death.

Perspective:

The data do not provide insight into the specific reasons that beta-blockers and calcium channel blockers had a favorable effect on survival. Possible explanations include the prevention of tachycardia-induced cardiomyopathy, better control of hypertension, and in the case of beta-blockers, reduction in risk of sudden death among the patients with structural heart disease. A majority of studies examining the effect of digoxin on survival in patients with AF have reported a deleterious effect on survival, and the current study provides additional data supporting the avoidance of digoxin in patients with AF.


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