Research Activities, February 2014
Study compares rate versus rhythm control in management of atrial fibrillation
Atrial fibrillation (AF), an irregular heart rhythm, represents the most common dysrhythmia in the United States, and contributes significantly to health care expenditures. Management of AF varies and may include medical and interventional therapies to maintain sinus rhythm ("rhythm control"), as well as strategies to control the ventricular rate. The appropriate criteria for selecting a management strategy in patients with AF have not been well-defined. Therefore, it is largely left to providers to determine which patients are suitable for rate control alone versus the combination of rate plus rhythm control.
A new study comparing rate versus rhythm control for management of AF in clinical practice found that, among 10,061 outpatients with AF, over two-thirds were managed with a rate-control-only strategy. The rate-control patients tended to be older, to have more coexisting medical illnesses, and were more likely to be cognitively impaired. Longstanding persistent AF and primary care management were also associated with rate control management. Patients managed with rhythm control had lower resting heart rates, and generally received less aggressive strategies to prevent blood clots. For example, they were more likely to be taking aspirin alone and less likely to be treated with oral anticoagulation medication such as warfarin. Systemic anticoagulation was prescribed for 69 percent (2,219) of rhythm-control patients compared to 79 percent (5,548) of rate-control patients.
Regardless of treatment strategy, there remains room for improvement in the management of patients with AF, suggest the study authors.Their study was supported by AHRQ (HS21092).
See "Rate versus rhythm control for management of atrial fibrillation in clinical practice: Results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry," by Benjamin A. Steinberg, M.D., DaJuanicia N. Holmes, M.S., Michael D. Ezekowitz, M.D., and others in the American Heart Journal 165, pp. 622-629, 2013.