- 作者：Nasir Shariff ; Ravi V. Desai ; Kanan Patel ; Mustafa I. Ahmed ; Gregg C. Fonarow ; Michael W. Rich ; Inmaculada B. Aban ; Maciej Banach ; Thomas E. Love ; Michel White ; Wilbert S. Aronow ; Andrew E. Epstein ; Ali Ahmed
- 关键词：Atrial fibrillation ; Hospitalization ; Mortality ; Propensity score ; Older adults ; Rate control ; Rhythm control
- 刊名：The American Journal of Medicine
- 出版年：2013
- 出版时间：October, 2013
- 年：2013
- 卷：126
- 期：10
- 页码：887-893
- 全文大小：718 K
lass=""h4"">Background
The prevalence of atrial fibrillation substantially increases after 70 years of age. However, the effect of rate-control versus rhythm-control strategies on outcomes in these patients remains unclear.lass=""h4"">Methods
In the randomized Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial, 4060 patients (mean age 70 years, range 49-80 years) with paroxysmal and persistent atrial fibrillation were randomized to rate-control versus rhythm-control strategies. Of these, 2248 were 70-80 years, of whom 1118 were in the rate-control group. Propensity scores for rate-control strategy were estimated for each of the 2248 patients and were used to assemble a cohort of 937 pairs of patients receiving rate-control versus rhythm-control strategies, balanced on 45 baseline characteristics.
lass=""h4"">Results
Matched patients had a mean age of 75 years; 45 % were women, 7 % were nonwhite, and 47 % had prior hospitalizations due to arrhythmias. During 3.4 years of mean follow-up, all-cause mortality occurred in 18 % and 23 % of matched patients in the rate-control and rhythm-control groups, respectively (hazard ratio [HR] associated with rate control, 0.77; 95 % confidence interval [CI], 0.63-0.94; P?= .010). HRs (95 % CIs) for cardiovascular and noncardiovascular mortality associated with rate control were 0.88?(0.65-1.18) and 0.62 (0.46-0.84), respectively. All-cause hospitalization occurred in 61 % and 68 % of?rate-control and rhythm-control patients, respectively (HR 0.76; 95 % CI, 0.68-0.86). HRs (95 % CIs) for?cardiovascular and noncardiovascular hospitalization were 0.66 (0.56-0.77) and 1.07 (0.91-1.27), respectively.
lass=""h4"">Conclusion
In septuagenarian patients with atrial fibrillation, compared with rhythm-control, a rate-control strategy was associated with significantly lower mortality and hospitalization.