Early Rhythm Control May Benefit Low-Risk A-Fib Patients

TUESDAY, Sept. 6, 2022 (HealthDay News) -- For patients with recently diagnosed atrial fibrillation (AF) and low stroke risk, early rhythm control compared with rate control is associated with a consistently lower risk for adverse cardiovascular outcomes, according to a study published online Sept. 6 in the Annals of Internal Medicine.

Daehoon Kim, M.D., M.P.H., from Yonsei University College of Medicine in Seoul, South Korea, and colleagues note that rhythm control is associated with a lower risk for adverse cardiovascular outcomes compared with usual care among patients recently diagnosed with atrial fibrillation with a CHA₂DS₂-VASc score of approximately ≥2 in the Early Treatment of Atrial Fibrillation for Stroke Prevention Trial (EAST-AFNET 4). The researchers examined whether these results can be generalized to patients with a low risk for stroke. The effect of early rhythm control on a primary composite outcome was compared among eligible and ineligible patients for EAST-AFNET4.

Data were included for 54,216 patients with AF with early rhythm control or rate control therapy; 69.3 percent were eligible for the trial (median CHA₂DS₂-VASc score, 4). The researchers found that among these patients, early rhythm control was associated with a reduced risk for the primary composite outcome versus rate control (hazard ratio, 0.86). For the 16,659 low-risk participants who did not meet the inclusion criteria (CHA₂DS₂-VASc score, 1), there was a consistent association observed for early rhythm control with a lower risk for the primary outcome (hazard ratio, 0.81).

"The beneficial association between early rhythm control (versus rate control) and cardiovascular outcomes was consistently observed in low-risk patients who did not meet the EAST-AFNET 4 eligibility criteria, as well as in the eligible patients," the authors write.

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