Treatment timing and the effects of rhythm control strategy in patients with atrial fibrillation: nationwide cohort study.

Published on May 11, 2021in BMJ30.223
· DOI :10.1136/BMJ.N991
Daehoon Kim8
Estimated H-index: 8
(Yonsei University),
Pil Sung Yang20
Estimated H-index: 20
+ 8 AuthorsBoyoung Joung46
Estimated H-index: 46
(Yonsei University)
Sources
Abstract
Abstract Objective To investigate whether the results of a rhythm control strategy differ according to the duration between diagnosis of atrial fibrillation and treatment initiation. Design Longitudinal observational cohort study. Setting Population based cohort from the Korean National Health Insurance Service database. Participants 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. Main outcome measure A composite outcome of death from cardiovascular causes, ischaemic stroke, admission to hospital for heart failure, or acute myocardial infarction. Results 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 v 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 v 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. Conclusions 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.
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#1Daehoon Kim (Yonsei University)H-Index: 8
#2Pil Sung YangH-Index: 20
Last. Boyoung Joung (Yonsei University)H-Index: 46
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Aims Accumulating evidence shows that atrial fibrillation (AF) is associated with an increased risk of dementia. Catheter ablation for AF prolongs the duration of sinus rhythm, thereby improving the quality of life. We investigated the association of catheter ablation for AF with the occurrence of dementia. Methods and results Using the Korean National Health Insurance Service database, among 194 928 adults with AF treated with ablation or medical therapy (antiarrhythmic or rate control drugs) b...
5 CitationsSource
#1Seng Chan You (Ajou University)H-Index: 7
#1Seng Chan You (Ajou University)H-Index: 13
Last. Harlan M. Krumholz (Yale University)H-Index: 215
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Importance Current guidelines recommend ticagrelor as the preferred P2Y12 platelet inhibitor for patients with acute coronary syndrome (ACS), primarily based on a single large randomized clinical trial. The benefits and risks associated with ticagrelor vs clopidogrel in routine practice merits attention. Objective To determine the association of ticagrelor vs clopidogrel with ischemic and hemorrhagic events in patients undergoing percutaneous coronary intervention (PCI) for ACS in clinical pract...
13 CitationsSource
#1Paulus Kirchhof (UHH: University of Hamburg)H-Index: 108
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Abstract Background Despite improvements in the management of atrial fibrillation, patients with this condition remain at increased risk for cardiovascular complications. It is unclear whether earl...
100 CitationsSource
#1Stephan Willems (Semmelweis University)H-Index: 58
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40 CitationsSource
#1Daniel B. Mark (Duke University)H-Index: 136
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Importance Catheter ablation is more effective than drug therapy in restoring sinus rhythm in patients with atrial fibrillation (AF), but its incremental effect on long-term quality of life (QOL) is uncertain. Objective To determine whether catheter ablation is more beneficial than conventional drug therapy for improving QOL in patients with AF. Design, Setting, and Participants An open-label randomized clinical trial of catheter ablation vs drug therapy in 2204 symptomatic patients with AF olde...
140 CitationsSource
#1Daehoon Kim (University Health System)H-Index: 8
#2Pil Sung YangH-Index: 20
Last. Gregory Y.H. LipH-Index: 195
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Objective Temporal changes in the healthcare burden of atrial fibrillation (AF) are less well known in rapidly ageing Asian countries. We examined trends in hospitalisations, costs, treatment patterns and outcomes related to AF in Korea. Methods Using the National Health Insurance Service (NHIS) database involving the entire adult Korean population (n=41 701 269 in 2015), we analysed a nationwide AF cohort representing 931 138 patients with AF. We studied all hospitalisations due to AF from 2006...
47 CitationsSource
#1Daehoon Kim (Yonsei University)H-Index: 8
#2Pil Sung YangH-Index: 20
Last. Gregory Y.H. LipH-Index: 195
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Abstract Background The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for High Blood Pressure in Adults redefined hypertension as systolic blood pressure (BP) ≥130 mm Hg or diastolic BP ≥80 mm Hg. The optimal BP for patients with atrial fibrillation (AF) is uncertain. Objectives The goal of this study was to investigate the impacts of the 2017 ACC/AHA guideline and to determine the ideal BP threshold for the management of high BP in patients with AF. Methods ...
39 CitationsSource
Cited By0
Newest
#1M.N. Kim (Yonsei University)
#2Seng Chan You (Yonsei University)H-Index: 13
Last. Boyoung Joung (Yonsei University)H-Index: 46
view all 0 authors...
Abstract null Background null Catheter ablation is more effective than antiarrhythmic drug therapy alone in patients with atrial fibrillation (AF). However, there are limited data on the outcomes of AF ablation according to sex. The purpose of this study was to evaluate gender differences in the actual outcomes after catheter ablation for atrial fibrillation. null Methods null Of 801,710 patients with AF in the Korean National Health Insurance Service database, we identified 9175 patients withou...
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