Real-world applicability and impact of early rhythm control for European patients with atrial fibrillation: a report from the ESC-EHRA EORP-AF Long-Term General Registry,Clinical Research in Cardiology

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Real-world applicability and impact of early rhythm control for European patients with atrial fibrillation: a report from the ESC-EHRA EORP-AF Long-Term General Registry
Clinical Research in Cardiology ( IF 3.8 ) Pub Date : 2021-08-27 , DOI: 10.1007/s00392-021-01914-y
Marco Proietti _{1,

2,

3} , Marco Vitolo _{1,

4} , Stephanie L Harrison ₁ , Deirdre A Lane _{1,

5} , Laurent Fauchier ₆ , Francisco Marin ₇ , Michael Nabauer ₈ , Tatjana S Potpara _{9,

10} , Gheorghe-Andrei Dan ₁₁ , Giuseppe Boriani ₄ , Gregory Y H Lip _{1,

5} ,

Affiliation

Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy.
Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France.
Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBERCV, Murcia, Spain.
Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany.
School of Medicine, University of Belgrade, Belgrade, Serbia.
Intensive Arrhythmia Care, Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia.
Colentina University Hospital, 'Carol Davila' University of Medicine, Bucharest, Romania.

Background

Use of rate/rhythm control is essential to control symptoms in patients with atrial fibrillation (AF). Recently, the EAST-AFNET 4 trial described how early rhythm control strategy was associated with a lower risk of adverse clinical outcomes.

Objectives

The aim was to evaluate the real-world applicability and impact of an early rhythm control strategy in patients with AF.

Methods

Use of an early rhythm control strategy was assessed in a European cohort of AF patients derived from the EHRA-ESC EORP-AF General Long-Term Registry. Early rhythm control was defined as use of antiarrhythmic drugs or cardioversion/catheter ablation. The primary outcome included cardiovascular death, stroke, acute coronary syndrome, and worsening of heart failure. Quality of life and health-care resource usage were also assessed as outcomes.

Results

Among the 10,707 patients evaluated for eligibility to EAST-AFNET 4, a total of 3774 (34.0%) were included. Early rhythm control was associated with better quality of life, but with greater use of health-care resources. During follow-up, the primary outcome occurred less often in early rhythm control patients than in those with no rhythm control (13.6% vs. 18.5%, p < 0.001). In the multivariate adjusted Cox regression model, no significant difference was found between no rhythm control and early rhythm control, for the primary outcome. No difference in the primary outcome between early rhythm control and ‘no rhythm control patients’ adherent to Atrial fibrillation Better Care (ABC) pathway’ was evident (p = 0.753)

Conclusions

Use of an early rhythm control strategy was associated with a lower rate of major adverse events, but this difference was non-significant on multivariate analysis, being mediated by differences in baseline characteristics and clinical risk profile. Early rhythm control was associated with a higher use of health-care resources and risk of hospital admission, despite showing better quality of life.

Graphic abstract

中文翻译：

早期节律控制对欧洲心房颤动患者的现实世界适用性和影响：ESC-EHRA EORP-AF 长期综合登记处的报告

背景

使用心率/节律控制对于控制心房颤动 (AF) 患者的症状至关重要。最近，EAST-AFNET 4 试验描述了早期节律控制策略如何与降低不良临床结果的风险相关。

目标

目的是评估早期节律控制策略在 AF 患者中的实际适用性和影响。

方法

在来自 EHRA-ESC EORP-AF 一般长期登记的欧洲 AF 患者队列中评估了早期节律控制策略的使用。早期节律控制被定义为使用抗心律失常药物或心脏复律/导管消融。主要结局包括心血管死亡、中风、急性冠状动脉综合征和心力衰竭恶化。生活质量和医疗保健资源的使用也被评估为结果。

结果

在评估符合 EAST-AFNET 4 资格的 10,707 名患者中，共有 3774 名（34.0%）被纳入。早期节律控制与更好的生活质量相关，但更多地使用医疗保健资源。在随访期间，早期节律控制患者的主要结局发生率低于没有节律控制的患者（13.6% vs. 18.5%，p < 0.001）。在多变量调整的 Cox 回归模型中，对于主要结果，未发现节律控制和早期节律控制之间没有显着差异。早期节律控制和“无节律控制患者”依从房颤更好的护理 (ABC) 途径之间的主要结果没有明显差异 ( p = 0.753)