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Early Rhythm Control Therapy for Atrial Fibrillation in Low-Risk Patients : A Nationwide Propensity Score-Weighted Study

 Daehoon Kim  ;  Pil-Sung Yang  ;  Seng Chan You  ;  Eunsun Jang  ;  Hee Tae Yu  ;  Tae-Hoon Kim  ;  Hui-Nam Pak  ;  Moon-Hyoung Lee  ;  Gregory Y H Lip  ;  Jung-Hoon Sung  ;  Boyoung Joung 
 ANNALS OF INTERNAL MEDICINE, Vol.175(10) : 1356-1365, 2022-10 
Journal Title
Issue Date
Aged ; Anti-Arrhythmia Agents* / therapeutic use ; Atrial Fibrillation* / drug therapy ; Clinical Trials as Topic ; Cohort Studies ; Humans ; Middle Aged ; Propensity Score ; Risk Assessment / methods ; Risk Factors ; Stroke / prevention & control
Background: Rhythm control is associated with lower risk for adverse cardiovascular outcomes compared with usual care among patients recently diagnosed with atrial fibrillation (AF) with a CHA2DS2-VASc score of approximately 2 or greater in EAST-AFNET 4 (Early Treatment of Atrial Fibrillation for Stroke Prevention Trial).

Objective: To investigate whether the results can be generalized to patients with low stroke risk.

Design: Population-based cohort study.

Setting: Nationwide claims database of the Korean National Health Insurance Service.

Participants: 54 216 patients with AF having early rhythm control (antiarrhythmic drugs or ablation) or rate control therapy that was initiated within 1 year of the AF diagnosis.

Measurements: The effect of early rhythm control on the primary composite outcome of cardiovascular death, ischemic stroke, hospitalization for heart failure, or myocardial infarction was compared between eligible and ineligible patients for EAST-AFNET 4 (CHA2DS2-VASc score, approximately 0 to 1) using propensity overlap weighting.

Results: In total, 37 557 study participants (69.3%) were eligible for the trial (median age, 70 years; median CHA2DS2-VASc score, 4), among whom early rhythm control was associated with lower risk for the primary composite outcome than rate control (hazard ratio, 0.86 [95% CI, 0.81 to 0.92]). Among the 16 659 low-risk patients (30.7%) who did not meet the inclusion criteria (median age, 54 years; median CHA2DS2-VASc score, 1), early rhythm control was consistently associated with lower risk for the primary outcome (hazard ratio, 0.81 [CI, 0.66 to 0.98]). No significant differences in safety outcomes were found between the rhythm and rate control strategies regardless of trial eligibility.

Limitation: Residual confounding.

Conclusion: In routine clinical practice, the beneficial association between early rhythm control and cardiovascular complications was consistent among low-risk patients regardless of trial eligibility.

Primary funding source: The Ministry of Health and Welfare and the Ministry of Food and Drug Safety, Republic of Korea.
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1. College of Medicine (의과대학) > Dept. of Biomedical Systems Informatics (의생명시스템정보학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 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
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
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