Health status outcomes after cardioversion for atrial fibrillation: results from the Assessment of Cardioversion Using Transesophageal Echocardiography (ACUTE) II Trial.
BACKGROUND
Atrial fibrillation is the most common significant cardiac arrhythmia and substantially impacts the health status of patients. Enoxaparin has been shown to be a safe and effective alternative to unfractionated heparin for use with transesophageal echocardiography (TEE)-guided cardioversion, but the implications on health status remain unknown. The aim of the study was to compare the health status outcomes of patients who undergo TEE-guided cardioversion with enoxaparin or unfractionated heparin as anticoagulation bridging therapy.


METHODS
The Assessment of Cardioversion Using Transesophageal Echocardiography (ACUTE) II multicenter trial randomized 155 patients to bridging therapy with either enoxaparin or unfractionated heparin. Of these, 118 were included in the health status substudy. Health status was assessed at baseline and 5 weeks using the RAND 36-item health survey (RAND-36), the Duke Activity Status Index (DASI), and the Health Utilities Index Mark 3 (HUI-3).


RESULTS
There were no significant differences in the health status measures between the treatment groups. However, patients who remained in normal sinus rhythm at follow-up had absolute improvement in all measures of health status, whereas patients in atrial fibrillation at follow-up had an absolute decrease in the DASI, HUI-3, and 5 of 8 subscales of the RAND-36. These findings reached statistical significance in the HUI-3 and 3 of 8 subscales of the RAND-36.


CONCLUSIONS
Health status outcomes in TEE-guided cardioversion do not significantly differ between anticoagulant bridging therapy with enoxaparin or unfractionated heparin. However, maintenance of sinus rhythm at 5 weeks was associated with an improvement in health status.
Elliott
Daniel J
DJ
University of Pennsylvania Division of General Internal Medicine, Philadelphia, PA, USA. eldaniel@mail.med.upenn.edu
Zhao
Liping
L
Jasper
Susan E
SE
Lieber
Elizabeth A
EA
Klein
Allan L
AL
Weintraub
William S
WS
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000628:therapy*; D017548:Echocardiography, Transesophageal; D004554:Electric Countershock / Q000379:methods*; D017984:Enoxaparin / Q000627:therapeutic use*; D005260:Female; D006304:Health Status; D006493:Heparin / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D000925:Anticoagulants; D017984:Enoxaparin; D006493:Heparin