Analysis of cause-specific mortality in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study.
BACKGROUND
Expectations that reestablishing and maintaining sinus rhythm in patients with atrial fibrillation might improve survival were disproved in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. This report describes the cause-specific modes of death in the AFFIRM treatment groups.


RESULTS
All deaths in patients enrolled in AFFIRM underwent blinded review by the AFFIRM Events Committee, and a mode of death was assigned. In AFFIRM, 2033 patients were randomized to a rhythm-control strategy and 2027 patients to a rate-control strategy. During a mean follow-up of 3.5 years, there were 356 deaths in the rhythm-control patients and 310 deaths in the rate-control patients (P=0.07). In the rhythm-control group, 129 patients (9%) died of a cardiac cause, and in the rate-control group, 130 patients (10%) died (P=0.95). Both groups had similar rates of arrhythmic and nonarrhythmic cardiac deaths. The numbers of vascular deaths were similar in the 2 groups: 35 (3%) in the rhythm-control group and 37 (3%) in the rate-control group (P=0.82). There were no differences in the rates of ischemic stroke and central nervous system hemorrhage. In the rhythm-control group, there were 169 noncardiovascular deaths (47.5% of the total number of deaths), whereas in the rate-control arm, there were 113 noncardiovascular deaths (36.5% of the total number of deaths) (P=0.0008). Differences in noncardiovascular death rates were due to pulmonary and cancer-related deaths.


CONCLUSIONS
Management of atrial fibrillation with a rhythm-control strategy conferred no advantage over a rate-control strategy in cardiac or vascular mortality and may be associated with an increased noncardiovascular death rate.
Steinberg
Jonathan S
JS
Division of Cardiology, St Luke's-Roosevelt Hospital Center and Columbia University, New York, NY 10025, USA. jss7@columbia.edu
Sadaniantz
Ara
A
Kron
Jack
J
Krahn
Andrew
A
Denny
D Marty
DM
Daubert
James
J
Campbell
W Barton
WB
Havranek
Edward
E
Murray
Katherine
K
Olshansky
Brian
B
O'Neill
Gearoid
G
Sami
Magdi
M
Schmidt
Stanley
S
Storm
Randle
R
Zabalgoitia
Miguel
M
Miller
John
J
Chandler
Mary
M
Nasco
Elaine M
EM
Greene
H Leon
HL
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000401:mortality*; D005500:Follow-Up Studies; D006801:Humans; D016016:Proportional Hazards Models; D016019:Survival Analysis
D000889:Anti-Arrhythmia Agents