Rhythm versus rate control in the contemporary management of atrial fibrillation in-hospital.
Little is presently known regarding whether a rhythm-control or a rate-control strategy is more frequently used in patients hospitalized for atrial fibrillation (AF). This study was conducted to assess patient and physician characteristics associated with each treatment strategy and with the use of anticoagulants. Hospitalizations for primary diagnoses of AF were examined using hospital claims from January 2000 to December 2004. Patients who received antiarrhythmic drugs, ablation, or cardioversion for AF were categorized as receiving rhythm control. Patients managed only with beta blockers, calcium channel blockers, or digoxin were categorized as receiving rate control. Characteristics associated with rhythm compared with rate control and anticoagulant use with CHADS(2) score were determined. The study cohort included 155,731 hospitalizations from 464 hospitals. Of these, 75,397 (48%) were categorized as involving rhythm control and 80,334 (52%) as involving rate control. Care by a noncardiologist (adjusted odds ratio [OR] 0.33, 95% confidence interval [CI] 0.31 to 0.36) and increasing age >65 years (adjusted OR 0.87, 95% CI 0.86 to 0.88) were associated with lower odds of rhythm versus rate control; hypertrophic cardiomyopathy was associated with greater odds (adjusted OR 2.3, 95% CI 1.81 to 2.84) of rhythm control. Warfarin use was greater in the rhythm-control group compared with the rate-control group (adjusted OR 1.56, 95% CI 1.52 to 1.60), and warfarin use was greater with a CHADS(2) score > or =2 (unadjusted OR 1.21, 95% CI 1.19 to 1.24). In conclusion, rhythm- and rate-control strategies were used equally in patients hospitalized for AF. Some observations, such as greater use of the rate-control strategy with increasing age, were consistent with recommendations, but others, such as lower use of warfarin in the rate-control group, were not.
Allen Lapointe
Nancy M
NM
Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA. allen003@mc.duke.edu
Sun
Jie-Lena
JL
Kaplan
Sigal
S
d'Almada
Phil
P
Al-Khatib
Sana M
SM
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000628:therapy*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002312:Cardiomyopathy, Hypertrophic / Q000453:epidemiology; D017115:Catheter Ablation; D004077:Digoxin / Q000627:therapeutic use; D004363:Drug Utilization / Q000706:statistics & numerical data; D004554:Electric Countershock; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008511:Medicine; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013038:Specialization; D014481:United States / Q000453:epidemiology; D014859:Warfarin / Q000627:therapeutic use; D014927:Wolff-Parkinson-White Syndrome / Q000453:epidemiology
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants; D002121:Calcium Channel Blockers; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D004077:Digoxin; D001241:Aspirin