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Rate control and clinical outcomes in patients with atrial fibrillation and obstructive lung disease

 Seng Chan You  ;  Min Ho An  ;  Dukyong Yoon  ;  Ga-Young Ban  ;  Pil-Sung Yang  ;  Hee Tae Yu  ;  Rae Woong Park  ;  Boyoung Joung 
 HEART RHYTHM, Vol.15(12) : 1825-1832, 2018 
Journal Title
Issue Date
Adrenergic beta-Antagonists/therapeutic use* ; Aged ; Anti-Arrhythmia Agents/therapeutic use ; Atrial Fibrillation/complications ; Atrial Fibrillation/drug therapy* ; Atrial Fibrillation/physiopathology ; Cause of Death/trends ; Digoxin/therapeutic use* ; Female ; Heart Rate/drug effects ; Heart Rate/physiology* ; Humans ; Lung Diseases, Obstructive/complications* ; Lung Diseases, Obstructive/mortality ; Lung Diseases, Obstructive/physiopathology ; Male ; Propensity Score ; Republic of Korea/epidemiology ; Retrospective Studies ; Survival Rate/trends
Adrenergic beta-antagonist ; Atrial fibrillation ; Calcium channel blocker ; Digoxin ; Heart rate ; Obstructive lung disease
BACKGROUND: Rate-control medications are considered first-line treatment for patients with atrial fibrillation (AF). However, obstructive lung disease (OLD), a condition prevalent in those with AF, often makes it difficult to use those medications because of the lack of studies on new-onset AF in patients with OLD. OBJECTIVE: The purpose of this study was to investigate clinical outcomes after administration of each class of rate-control medication in patients with concomitant AF and OLD (AF-OLD). METHODS: This study used the entire database provided by the National Health Insurance Service from 2002 to 2015. Risk of all-cause mortality was compared between use of calcium channel blocker (CCB) and use of other drug classes in AF-OLD patients using Cox regression analyses after propensity score matching. RESULTS: Among the 13,111 patients, the number of AF-OLD patients treated with a CCB, cardioselective β-blocker (BB), nonselective BB, and digoxin was 2482, 2379, 2255, and 5995, respectively. The risk of mortality was lower with use of selective BB (hazard ratio [HR] 0.84; 95% confidence interval [CI] 0.75-0.94; P = .002) and nonselective BB (HR 0.85; 95% CI 0.77-0.95; P = .003) compared to use of CCBs. Digoxin use was related with worse survival, with marginal statistical significance (HR 1.09; 95% CI 1.00-1.18; P = .053). CONCLUSION: Among patients with AF-OLD, rate-control treatment using selective and nonselective BB was associated with a significant reduction in mortality compared with CCB use. Further prospective randomized trials are required to confirm these findings.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Yang, Pil Sung(양필성)
Yu, Hee Tae(유희태) ORCID logo https://orcid.org/0000-0002-6835-4759
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
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