Rate vs. rhythmcontrol and adverse outcomes among European patients with atrial fibrillation

Aim The impact of rate and rhythm control strategies on outcomes in patients with atrial fibrillation (AF) remains controversial.Our aims were: to report use of rate and rhythm control strategies in European patients from theEURObservational Research Program AF General Pilot Registry. Secondly, to evaluate outcomes according to assignedstrategies............................................................................................................................................................Methodsand resultsUse of pure rate and rhythm control agents was described according to European regions. 1-year follow-up datawere reported. Among rate control strategies, beta-blockers were the most commonly used drug. Proportions ofpatients assigned to rhythm control varied greatly between countries, and amiodarone was the most used rhythmcontrol drug. Of the original 3119 patients, 1036 (33.2%) were assigned to rate control only and 355 (11.4%) torhythm control only. Patients assigned to a rate control strategy were older (P < 0.0001) and more likely female(P = 0.0266). Patients assigned to a rate control strategy had higher rates for any thrombo-embolic event(P = 0.0245), cardiovascular death (P = 0.0437), and all-cause death (P < 0.0001). Kaplan–Meier analysis showed thatrate control strategy was associated with a higher risk for all-cause death (P < 0.001). On Cox regression analysis,rate control strategy was independently associated with all-cause death (P = 0.0256). A propensity matched analysisonly found a trend for the association between rate control and all-cause death (P = 0.0664)............................................................................................................................................................Conclusion In a European AF patients’ cohort, a pure rate control strategy was associated with a higher risk for adverse eventsat 1-year follow-up, and partially adjusted analysis suggested that rate control independently increased the risk forall-cause death. A fully adjusted propensity score matched analysis found that this association was no longer statisticallysignificant, suggesting an important role of comorbidities in determining the higher risk for all-cause death.