Rhythm versus rate control in patients with newly diagnosed atrial fibrillation – Observations from the GARFIELD-AF registry
Issued Date
2023-12-01
Resource Type
ISSN
23529067
Scopus ID
2-s2.0-85178908620
Journal Title
IJC Heart and Vasculature
Volume
49
Rights Holder(s)
SCOPUS
Bibliographic Citation
IJC Heart and Vasculature Vol.49 (2023)
Suggested Citation
Knudsen Pope M., Hall T.S., Virdone S., Atar D., John Camm A., Pieper K.S., Jansky P., Haas S., Goto S., Panchenko E., Baron-Esquivias G., Angchaisuksiri P., Kakkar A.K. Rhythm versus rate control in patients with newly diagnosed atrial fibrillation – Observations from the GARFIELD-AF registry. IJC Heart and Vasculature Vol.49 (2023). doi:10.1016/j.ijcha.2023.101302 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/91510
Title
Rhythm versus rate control in patients with newly diagnosed atrial fibrillation – Observations from the GARFIELD-AF registry
Author's Affiliation
Other Contributor(s)
Abstract
Background: Investigate real-world outcomes of early rhythm versus rate control in patients with recent onset atrial fibrillation. Methods: The Global Anticoagulant Registry in the FIELD-AF (GARFIELD-AF) is an international multi-centre, non-interventional prospective registry of newly diagnosed (≤6 weeks’ duration) atrial fibrillation patients at risk for stroke. Patients were stratified according to treatment initiated at baseline (≤48 days post enrolment), and outcome risks evaluated by overlap propensity weighted Cox proportional-hazards models. Results: Of 45,382 non-permanent atrial fibrillation patients, 23,858 (52.6 %) received rhythm control and 21,524 (47.4 %) rate control. Rhythm-controlled patients had lower median age (68.0 [Q1;Q3: 60.0;76.0] versus 73.0 [65.0;79.0]), fewer histories of stroke/transient ischemic attack/systemic embolism (9.4 % versus 13.0 %), and lower expected probabilities of death (median GARFIELD-AF death score 4.0 [2.3;7.5] versus 5.1 [2.8;9.2]). The two groups had the same median CHA2DS2-VASc scores (3.0 [2.0;4.0]) and similar proportions of anticoagulated patients (rhythm control: 66.0 %, rate control: 65.5 %). The propensity-score-weighted hazard ratios of rhythm vs rate control (reference) were 0.85 (95 % CI: 0.79–0.92, p-value < 0.0001) for all-cause mortality, 0.84 (0.72–0.97, p-value 0.020) for non-haemorrhagic stroke/systemic embolism and 0.90 (0.78–1.04, p-value 0.164) for major bleeding. Conclusion: Rhythm control strategy was initiated in about half of the patients with newly diagnosed non-valvular non-permanent atrial fibrillation. After balancing confounders, significantly lower risks of all-cause mortality and non-haemorrhagic stroke were observed in patients who received early rhythm control.