Atrial Fibrillation Presentation and Early Rhythm Control Outcomes
- Early rhythm control reduces cardiovascular complications in patients with first-diagnosed AF, paroxysmal AF, and persistent AF.
- Patients with first-diagnosed AF managed with early rhythm control strategy face higher risks of hospitalization and acute coronary syndrome than those with paroxysmal AF or persistent AF.
What are the clinical characteristics and outcomes in patients presenting with different atrial fibrillation (AF) patterns on early rhythm control versus usual care?
This study was a prespecified analysis of the EAST-AFNET 4 (Early treatment of atrial fibrillation for stroke prevention) trial. The authors compared the effects of early rhythm control in first-diagnosed AF, paroxysmal AF, and persistent AF on primary outcomes in the trial over a mean follow-up of 5 years. They also compared impact of the AF phenotype on changes in health-related quality of life.
There were 1,048 first-diagnosed AF patients, 994 paroxysmal AF patients, and 743 persistent AF patients. Early rhythm control reduced the primary outcome (cardiovascular death, stroke, hospitalization for heart failure, and acute coronary syndrome) in all three AF patterns. Hospitalizations for acute coronary syndrome were highest in first-diagnosed AF (incidence rate ratio, 1.5) compared with paroxysmal AF and persistent AF. First-diagnosed AF patients spent more nights in the hospital than paroxysmal AF and persistent AF patients. Early rhythm control improved health-related quality of life in patients with paroxysmal AF and persistent AF but not in patients with first-diagnosed AF.
Early rhythm control reduces the first primary composite outcome in all AF patterns. Patients with first-diagnosed AF are at high risk for hospitalization and acute coronary syndrome, particularly on early rhythm control.
The EAST-AFNET 4 trial showed that early rhythm control therapy was associated with a lower risk of adverse cardiovascular outcomes than usual care among patients with early atrial fibrillation and cardiovascular conditions. The study employed both pharmacological and procedural means of achieving sinus rhythm, and it is one of the most impactful studies in the field of AF management in the last several years. The current report shows that early rhythm control reduces the first primary composite outcome in all AF patterns; first-diagnosed, paroxysmal, and persistent. However, patients with first-diagnosed AF are at a higher risk of hospitalization and acute coronary syndrome, particularly if they are treated with early rhythm control strategy. Those factors may help explain reduced quality-of-life measures in first-diagnosed AF patients compared to the other groups. It is not clear why first-diagnosed AF should have an increased risk, but it is possible that AF is being triggered by underlying pathophysiological processes which may be secondary to acute changes in the underlying health status. This should be explored in future investigations.
Clinical Topics: Acute Coronary Syndromes, Anticoagulation Management, Arrhythmias and Clinical EP, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Anticoagulation Management and ACS, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure
Keywords: Acute Coronary Syndrome, Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Geriatrics, Heart Failure, Outcome Assessment, Health Care, Quality of Life, Risk, Secondary Prevention, Stroke
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