Rhythm control versus rate control in patients with atrial fibrillation and heart failure across the left ventricular ejection fraction spectrum
Background: Rhythm control and rate control are both employed commonly in patients with atrial fibrillation (AF) and heart failure (HF), but limited real-world data exist on them. We aimed to compare outcomes between these two strategies across the left ventricular ejection fraction (LVEF) spectrum....
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-07-01
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| Series: | Hellenic Journal of Cardiology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1109966622000288 |
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| author | Dimitrios V. Moysidis Anastasios Kartas Athanasios Samaras Andreas S. Papazoglou Evangelos Akrivos Ioannis Vouloagkas Anastasios Papanastasiou Eleni Vrana Amalia Baroutidou Michail Botis Evangelos Liampas Christos Tsagkaris Efstratios Karagiannidis Haralambos Karvounis Apostolos Tzikas George Giannakoulas |
| author_facet | Dimitrios V. Moysidis Anastasios Kartas Athanasios Samaras Andreas S. Papazoglou Evangelos Akrivos Ioannis Vouloagkas Anastasios Papanastasiou Eleni Vrana Amalia Baroutidou Michail Botis Evangelos Liampas Christos Tsagkaris Efstratios Karagiannidis Haralambos Karvounis Apostolos Tzikas George Giannakoulas |
| author_sort | Dimitrios V. Moysidis |
| collection | DOAJ |
| description | Background: Rhythm control and rate control are both employed commonly in patients with atrial fibrillation (AF) and heart failure (HF), but limited real-world data exist on them. We aimed to compare outcomes between these two strategies across the left ventricular ejection fraction (LVEF) spectrum. Materials and methods: This retrospective cohort study used data from the randomized MISOAC-AF trial, including from patients with AF and coexistent HF who were hospitalized and followed up after discharge. At baseline, the patients were classified into pharmaceutical (or electrical cardioversion) rhythm control strategy or rate control treatment (b-blocker, digoxin, calcium channel blockers) groups. The primary outcome was all-cause mortality. Kaplan-Meier curves and multivariable-adjusted Cox regression were utilized to compare the two strategies. Spline curve models were used to demonstrate the results across the LVEF stratified spectrum. Results: In total, 199 AF patients with HF were studied (mean age, 77 years). At discharge, 73 (36.7%) patients received rhythm control and 126 (63.3%) rate control treatment. After a median follow-up period of 31 months, 26 (35.6%) patients in the rhythm-control group died, as compared to 43 (33.3%) in the rate-control group (aHR: 1.29; 95% CI: 0.78-2.14; p = 0.31). The spline curves also revealed no difference in all-cause mortality favoring either strategy in any HF subtype across the nominally classified LVEF. Conclusion: The use of a pharmacological rhythm-control strategy was not associated with a survival advantage compared to the rate control strategy in recently hospitalized patients with AF and comorbid HF. More randomized trials and large studies are needed in the future to explore these results in each subgroup of HF patients. |
| first_indexed | 2024-04-13T09:51:29Z |
| format | Article |
| id | doaj.art-f1726e5daff044ccb6eaa8b6aa88cb4c |
| institution | Directory Open Access Journal |
| issn | 1109-9666 |
| language | English |
| last_indexed | 2024-04-13T09:51:29Z |
| publishDate | 2022-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Hellenic Journal of Cardiology |
| spelling | doaj.art-f1726e5daff044ccb6eaa8b6aa88cb4c2022-12-22T02:51:34ZengElsevierHellenic Journal of Cardiology1109-96662022-07-01663240Rhythm control versus rate control in patients with atrial fibrillation and heart failure across the left ventricular ejection fraction spectrumDimitrios V. Moysidis0Anastasios Kartas1Athanasios Samaras2Andreas S. Papazoglou3Evangelos Akrivos4Ioannis Vouloagkas5Anastasios Papanastasiou6Eleni Vrana7Amalia Baroutidou8Michail Botis9Evangelos Liampas10Christos Tsagkaris11Efstratios Karagiannidis12Haralambos Karvounis13Apostolos Tzikas14George Giannakoulas15First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, GreeceFirst Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, GreeceFirst Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, GreeceFirst Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, GreeceLaboratory of Computing, Medical Informatics and Biomedical Imaging Technologies, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, GreeceFirst Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, GreeceFirst Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, GreeceFirst Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, GreeceFirst Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, GreeceFirst Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, GreeceFirst Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, GreeceFirst Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, GreeceFirst Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, GreeceFirst Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, GreeceInterbalkan European Medical Center, Asklipiou 10, Pylaia, Thessaloniki, GreeceFirst Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece; Corresponding author. George Giannakoulas, MD, PhD, Aristotle University of Thessaloniki, Department of Cardiology, AHEPA University Hospital, St. Kiriakidi 1, 54636, Thessaloniki, Greece. Tel.: +30 2310994830, Fax: +30 2310994673.Background: Rhythm control and rate control are both employed commonly in patients with atrial fibrillation (AF) and heart failure (HF), but limited real-world data exist on them. We aimed to compare outcomes between these two strategies across the left ventricular ejection fraction (LVEF) spectrum. Materials and methods: This retrospective cohort study used data from the randomized MISOAC-AF trial, including from patients with AF and coexistent HF who were hospitalized and followed up after discharge. At baseline, the patients were classified into pharmaceutical (or electrical cardioversion) rhythm control strategy or rate control treatment (b-blocker, digoxin, calcium channel blockers) groups. The primary outcome was all-cause mortality. Kaplan-Meier curves and multivariable-adjusted Cox regression were utilized to compare the two strategies. Spline curve models were used to demonstrate the results across the LVEF stratified spectrum. Results: In total, 199 AF patients with HF were studied (mean age, 77 years). At discharge, 73 (36.7%) patients received rhythm control and 126 (63.3%) rate control treatment. After a median follow-up period of 31 months, 26 (35.6%) patients in the rhythm-control group died, as compared to 43 (33.3%) in the rate-control group (aHR: 1.29; 95% CI: 0.78-2.14; p = 0.31). The spline curves also revealed no difference in all-cause mortality favoring either strategy in any HF subtype across the nominally classified LVEF. Conclusion: The use of a pharmacological rhythm-control strategy was not associated with a survival advantage compared to the rate control strategy in recently hospitalized patients with AF and comorbid HF. More randomized trials and large studies are needed in the future to explore these results in each subgroup of HF patients.http://www.sciencedirect.com/science/article/pii/S1109966622000288Heart FailureAtrial FibrillationRhythm controlRate controlLeft Ventricular Ejection Fraction |
| spellingShingle | Dimitrios V. Moysidis Anastasios Kartas Athanasios Samaras Andreas S. Papazoglou Evangelos Akrivos Ioannis Vouloagkas Anastasios Papanastasiou Eleni Vrana Amalia Baroutidou Michail Botis Evangelos Liampas Christos Tsagkaris Efstratios Karagiannidis Haralambos Karvounis Apostolos Tzikas George Giannakoulas Rhythm control versus rate control in patients with atrial fibrillation and heart failure across the left ventricular ejection fraction spectrum Hellenic Journal of Cardiology Heart Failure Atrial Fibrillation Rhythm control Rate control Left Ventricular Ejection Fraction |
| title | Rhythm control versus rate control in patients with atrial fibrillation and heart failure across the left ventricular ejection fraction spectrum |
| title_full | Rhythm control versus rate control in patients with atrial fibrillation and heart failure across the left ventricular ejection fraction spectrum |
| title_fullStr | Rhythm control versus rate control in patients with atrial fibrillation and heart failure across the left ventricular ejection fraction spectrum |
| title_full_unstemmed | Rhythm control versus rate control in patients with atrial fibrillation and heart failure across the left ventricular ejection fraction spectrum |
| title_short | Rhythm control versus rate control in patients with atrial fibrillation and heart failure across the left ventricular ejection fraction spectrum |
| title_sort | rhythm control versus rate control in patients with atrial fibrillation and heart failure across the left ventricular ejection fraction spectrum |
| topic | Heart Failure Atrial Fibrillation Rhythm control Rate control Left Ventricular Ejection Fraction |
| url | http://www.sciencedirect.com/science/article/pii/S1109966622000288 |
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