title: Analysis of cause-specific mortality in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study.
abstract: 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.
authors.affiliation: Division of Cardiology, St Luke's-Roosevelt Hospital Center and Columbia University, New York, NY 10025, USA. jss7@columbia.edu
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Steinberg
authors.forename: Ara
authors.initials: A
authors.lastname: Sadaniantz
authors.forename: Jack
authors.initials: J
authors.lastname: Kron
authors.forename: Andrew
authors.initials: A
authors.lastname: Krahn
authors.forename: D Marty
authors.initials: DM
authors.lastname: Denny
authors.forename: James
authors.initials: J
authors.lastname: Daubert
authors.forename: W Barton
authors.initials: WB
authors.lastname: Campbell
authors.forename: Edward
authors.initials: E
authors.lastname: Havranek
authors.forename: Katherine
authors.initials: K
authors.lastname: Murray
authors.forename: Brian
authors.initials: B
authors.lastname: Olshansky
authors.forename: Gearoid
authors.initials: G
authors.lastname: O'Neill
authors.forename: Magdi
authors.initials: M
authors.lastname: Sami
authors.forename: Stanley
authors.initials: S
authors.lastname: Schmidt
authors.forename: Randle
authors.initials: R
authors.lastname: Storm
authors.forename: Miguel
authors.initials: M
authors.lastname: Zabalgoitia
authors.forename: John
authors.initials: J
authors.lastname: Miller
authors.forename: Mary
authors.initials: M
authors.lastname: Chandler
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Nasco
authors.forename: H Leon
authors.initials: HL
authors.lastname: Greene
mesh_terms: 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
chemical_list: D000889:Anti-Arrhythmia Agents