Rhythm Control Versus Rate Control in Patients With Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction: Insights From Get With The Guidelines—Heart Failure
Background Limited data exist to guide treatment for patients with heart failure with preserved ejection fraction and atrial fibrillation, including the important decision regarding rate versus rhythm control. Methods and Results We analyzed the Get With The Guidelines—Heart Failure (GWTG‐HF) regist...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-12-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.011560 |
| _version_ | 1819205563987263488 |
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| author | Jacob P. Kelly Adam D. DeVore JingJing Wu Bradley G. Hammill Abhinav Sharma Lauren B. Cooper G. Michael Felker Jonathan P. Piccini Larry A. Allen Paul A. Heidenreich Eric D. Peterson Clyde W. Yancy Gregg C. Fonarow Adrian F. Hernandez |
| author_facet | Jacob P. Kelly Adam D. DeVore JingJing Wu Bradley G. Hammill Abhinav Sharma Lauren B. Cooper G. Michael Felker Jonathan P. Piccini Larry A. Allen Paul A. Heidenreich Eric D. Peterson Clyde W. Yancy Gregg C. Fonarow Adrian F. Hernandez |
| author_sort | Jacob P. Kelly |
| collection | DOAJ |
| description | Background Limited data exist to guide treatment for patients with heart failure with preserved ejection fraction and atrial fibrillation, including the important decision regarding rate versus rhythm control. Methods and Results We analyzed the Get With The Guidelines—Heart Failure (GWTG‐HF) registry linked to Medicare claims data from 2008 to 2014 to describe current treatments for rate versus rhythm control and subsequent outcomes in patients with heart failure with preserved ejection fraction and atrial fibrillation using inverse probability weighted analysis. Rhythm control was defined as use of an antiarrhythmic medication, cardioversion, or AF ablation or surgery. Rate control was defined as use of any combination of β‐blocker, calcium channel blocker, and digoxin without evidence of rhythm control. Among 15 682 fee‐for‐service Medicare patients, at the time of discharge, 1857 were treated with rhythm control and 13 825 with rate control, with minimal differences in baseline characteristics between groups. There was higher all‐cause death at 1 year in the rate control compared with the rhythm control group (37.5% and 30.8%, respectively, P<0.01). The lower 1‐year all‐cause death in the rhythm control group remained after risk adjustment (adjusted hazard ratio, 0.86; 95% CI, 0.75–0.98; P=0.02). Conclusions Rhythm control in patients aged 65 and older with heart failure with preserved ejection fraction and AF was associated with a lower risk of 1 year all‐cause mortality. Future prospective randomized studies are needed to explore this potential benefit. |
| first_indexed | 2024-12-23T04:53:42Z |
| format | Article |
| id | doaj.art-1c8ead4cf54d45cb85100d654f38d618 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-23T04:53:42Z |
| publishDate | 2019-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-1c8ead4cf54d45cb85100d654f38d6182022-12-21T17:59:24ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-12-0182410.1161/JAHA.118.011560Rhythm Control Versus Rate Control in Patients With Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction: Insights From Get With The Guidelines—Heart FailureJacob P. Kelly0Adam D. DeVore1JingJing Wu2Bradley G. Hammill3Abhinav Sharma4Lauren B. Cooper5G. Michael Felker6Jonathan P. Piccini7Larry A. Allen8Paul A. Heidenreich9Eric D. Peterson10Clyde W. Yancy11Gregg C. Fonarow12Adrian F. Hernandez13Duke Clinical Research Institute and Duke University Medical Center Durham NCDuke Clinical Research Institute and Duke University Medical Center Durham NCDuke Clinical Research Institute and Duke University Medical Center Durham NCDuke Clinical Research Institute and Duke University Medical Center Durham NCDuke Clinical Research Institute and Duke University Medical Center Durham NCDuke Clinical Research Institute and Duke University Medical Center Durham NCDuke Clinical Research Institute and Duke University Medical Center Durham NCDuke Clinical Research Institute and Duke University Medical Center Durham NCUniversity of Colorado School of Medicine Aurora COVeterans Affairs Palo Alto Healthcare System Palo Alto CADuke Clinical Research Institute and Duke University Medical Center Durham NCNorthwestern University, Feinberg School of Medicine Chicago ILAhmanson‐UCLA Cardiomyopathy Center University of California Los Angeles Medical Center Los Angeles CADuke Clinical Research Institute and Duke University Medical Center Durham NCBackground Limited data exist to guide treatment for patients with heart failure with preserved ejection fraction and atrial fibrillation, including the important decision regarding rate versus rhythm control. Methods and Results We analyzed the Get With The Guidelines—Heart Failure (GWTG‐HF) registry linked to Medicare claims data from 2008 to 2014 to describe current treatments for rate versus rhythm control and subsequent outcomes in patients with heart failure with preserved ejection fraction and atrial fibrillation using inverse probability weighted analysis. Rhythm control was defined as use of an antiarrhythmic medication, cardioversion, or AF ablation or surgery. Rate control was defined as use of any combination of β‐blocker, calcium channel blocker, and digoxin without evidence of rhythm control. Among 15 682 fee‐for‐service Medicare patients, at the time of discharge, 1857 were treated with rhythm control and 13 825 with rate control, with minimal differences in baseline characteristics between groups. There was higher all‐cause death at 1 year in the rate control compared with the rhythm control group (37.5% and 30.8%, respectively, P<0.01). The lower 1‐year all‐cause death in the rhythm control group remained after risk adjustment (adjusted hazard ratio, 0.86; 95% CI, 0.75–0.98; P=0.02). Conclusions Rhythm control in patients aged 65 and older with heart failure with preserved ejection fraction and AF was associated with a lower risk of 1 year all‐cause mortality. Future prospective randomized studies are needed to explore this potential benefit.https://www.ahajournals.org/doi/10.1161/JAHA.118.011560atrial fibrillationheart failure with preserved ejection fractionrate controlrhythm control |
| spellingShingle | Jacob P. Kelly Adam D. DeVore JingJing Wu Bradley G. Hammill Abhinav Sharma Lauren B. Cooper G. Michael Felker Jonathan P. Piccini Larry A. Allen Paul A. Heidenreich Eric D. Peterson Clyde W. Yancy Gregg C. Fonarow Adrian F. Hernandez Rhythm Control Versus Rate Control in Patients With Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction: Insights From Get With The Guidelines—Heart Failure Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atrial fibrillation heart failure with preserved ejection fraction rate control rhythm control |
| title | Rhythm Control Versus Rate Control in Patients With Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction: Insights From Get With The Guidelines—Heart Failure |
| title_full | Rhythm Control Versus Rate Control in Patients With Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction: Insights From Get With The Guidelines—Heart Failure |
| title_fullStr | Rhythm Control Versus Rate Control in Patients With Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction: Insights From Get With The Guidelines—Heart Failure |
| title_full_unstemmed | Rhythm Control Versus Rate Control in Patients With Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction: Insights From Get With The Guidelines—Heart Failure |
| title_short | Rhythm Control Versus Rate Control in Patients With Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction: Insights From Get With The Guidelines—Heart Failure |
| title_sort | rhythm control versus rate control in patients with atrial fibrillation and heart failure with preserved ejection fraction insights from get with the guidelines heart failure |
| topic | atrial fibrillation heart failure with preserved ejection fraction rate control rhythm control |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.011560 |
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