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

 Daehoon Kim  ;  Pil-Sung Yang  ;  Seng Chan You  ;  Jung-Hoon Sung  ;  Eunsun Jang  ;  Hee Tae Yu  ;  Tae-Hoon Kim  ;  Hui-Nam Pak  ;  Moon-Hyoung Lee  ;  Gregory Y H Lip  ;  Boyoung Joung 
 BMJ-BRITISH MEDICAL JOURNAL, Vol.373 : n991, 2021-05 
Journal Title
Issue Date
Aged ; Anti-Arrhythmia Agents / therapeutic use* ; Atrial Fibrillation / mortality ; Atrial Fibrillation / therapy* ; Catheter Ablation / statistics & numerical data* ; Databases, Factual ; Female ; Heart Failure / epidemiology ; Heart Rate / drug effects ; Hospitalization / statistics & numerical data ; Humans ; Incidence ; Ischemic Stroke / epidemiology ; Longitudinal Studies ; Male ; Middle Aged ; Myocardial Infarction / epidemiology ; Republic of Korea / epidemiology ; Retrospective Studies ; Time-to-Treatment*
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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1. College of Medicine (의과대학) > BioMedical Science Institute (의생명과학부) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine (예방의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dae Hoon(김대훈) ORCID logo https://orcid.org/0000-0002-9736-450X
Kim, Tae-Hoon(김태훈) ORCID logo https://orcid.org/0000-0003-4200-3456
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
You, Seng Chan(유승찬) ORCID logo https://orcid.org/0000-0002-5052-6399
Yu, Hee Tae(유희태) ORCID logo https://orcid.org/0000-0002-6835-4759
Lee, Moon-Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Jang, Eunsun(장은선) ORCID logo https://orcid.org/0000-0001-6991-4765
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
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