Rate-Control Versus Rhythm-Control Strategies and Outcomes in Septuagenarians With Atrial Fibrillation

Oct 15, 2013
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Authors:
Shariff N, Desai RV, Patel K, et al.
Citation:
Am J Med 2013;126:887-893.
Summary By:
Fred Morady, MD, FACC

Study Questions:

Do 70- to 80-year-old patients with atrial fibrillation (AF) have better outcomes with a rate- or rhythm-control treatment strategy?

Methods:

This was a post-hoc analysis of data from the AFFIRM trial. Matching based on propensity scores identified 937 pairs of patients 70-80 years old (mean age 75 years) randomly assigned to the rate- versus rhythm-control arms. The primary outcome was all-cause mortality.

Results:

All-cause mortality during a mean follow-up of 3.4 years was significantly lower in the rate-control patients (18%) than in the matched rhythm-control patients (23%). All-cause hospitalizations also were significantly lower in the rate-control patients (61%) than in the rhythm-control patients (68%).

Conclusions:

The authors concluded that septuagenarians with AF have better outcomes with a rate-control strategy than with a rhythm-control strategy.

Perspective:

In the AFFIRM trial, there was a trend toward lower mortality in the rate- compared to the rhythm-control arm. In this study, the difference in mortality between the two arms of the study was significantly different, suggesting that the harmful effects of rhythm-control agents are more pronounced in 70-80 year olds than in younger individuals. The results confirm that a rate-control strategy is appropriate in older patients with AF who are asymptomatic or minimally symptomatic. However, a rhythm-control strategy should be considered for patients who still have significant symptoms from AF despite adequate heart rate control. Recent studies suggest that the use of AF ablation for rhythm control as opposed to antiarrhythmic drugs can improve quality of life without compromising survival.

Keywords: Propensity Score, Heart Rate


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