Comparative effectiveness of rhythm control vs rate control drug treatment effect on mortality in patients with atrial fibrillation

Arch Intern Med. 2012 Jul 9;172(13):997-1004. doi: 10.1001/archinternmed.2012.2266.

Abstract

Background: Controversy continues concerning the choice of rhythm control vs rate control treatment strategies for atrial fibrillation (AF). A recent clinical trial showed no difference in 5-year mortality between the 2 treatments. We aimed to determine whether the 2 strategies have similar effectiveness when applied to a general population of patients with AF with longer follow-up.

Methods: We used population-based administrative databases from Quebec, Canada, from 1999 to 2007 to select patients 66 years or older hospitalized with an AF diagnosis who did not have AF-related drug prescriptions in the year before the admission but received a prescription within 7 days of discharge. Patients were followed until death or administrative censoring. Mortality was analyzed by multivariable Cox regression.

Results: Among 26,130 patients followed for a mean (SD) period of 3.1 years (2.3 years), there were 13,237 deaths (49.5%). After adjusting for covariates, we found that the effect of rhythm vs rate control drugs changed over time: after a small increase in mortality for patients treated with rhythm control in the 6 months following treatment initiation (hazard ratio [HR], 1.07; 95% CI, 1.01-1.14), the mortality was similar between the 2 groups until year 4 but decreased steadily in the rhythm control group after year 5 (HR, 0.89; 95% CI, 0.81-0.96; and HR, 0.77; 95% CI, 0.62-0.95, after 5 and 8 years, respectively).

Conclusions: In this population-based sample of patients with AF, we found little difference in mortality within 4 years of treatment initiation between patients with AF initiating rhythm control therapy vs those initiating rate control therapy. However, rhythm control therapy seems to be superior in the long-term.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Arrhythmia Agents / administration & dosage
  • Anti-Arrhythmia Agents / pharmacology
  • Anti-Arrhythmia Agents / therapeutic use*
  • Atrial Fibrillation / drug therapy*
  • Atrial Fibrillation / mortality*
  • Atrial Fibrillation / physiopathology
  • Comparative Effectiveness Research
  • Databases, Factual
  • Female
  • Heart Conduction System / drug effects*
  • Heart Conduction System / physiopathology*
  • Heart Rate / drug effects*
  • Humans
  • Male
  • Odds Ratio
  • Proportional Hazards Models
  • Quebec / epidemiology
  • Retrospective Studies
  • Survival Analysis
  • Treatment Outcome

Substances

  • Anti-Arrhythmia Agents