title: Comparison of the impact of the Atrial Fibrillation Follow-Up Investigation of Rhythm Management trial on prescribing patterns: a time-series analysis.
abstract: BACKGROUND
  The AFFIRM (Atrial Fibrillation Follow-Up Investigation of Rhythm Management) trial demonstrated that rate control and rhythm control strategies result in similar survival and quality of life for patients with atrial fibrillation (AF). Because of superior safety and lower cost, rate control is now the recommended strategy for the management of most elderly, high-risk AF patients.
  
  
  OBJECTIVE
  To determine the extent to which the AFFIRM trial results have been adopted into actual practice.
  
  
  METHODS
  We conducted a time-series analysis of 3 population-based cohorts of patients with AF who were 66 years of age or older in Pennsylvania and Ontario. We stratified patients in Ontario by socioeconomic status (SES) and examined changes in quarterly prescription rates for rate control and rhythm controlling medications as well as cardioversion procedures before and after publication of the AFFIRM trial.
  
  
  RESULTS
  The publication of the AFFIRM trial resulted in statistically significant reductions in the use of rhythm controlling medications in all 3 cohorts (p < 0.01). The magnitude of these changes in the non-low SES Canadian cohort was approximately 1% per quarter and was greater than the magnitude observed in the other cohorts (p < 0.001). The use of cardioversion procedures also decreased in all study regions (p < 0.01). In contrast, AFFIRM publication was also associated with a small increase in the use of rate controlling medications in Canada (p < 0.01) but not in the US (p = 0.23).
  
  
  CONCLUSIONS
  Publication of the AFFIRM trial resulted in small but statistically significant changes in the care of patients with AF.
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02120, USA. nchoudhry@partners.org
authors.forename: Niteesh K
authors.initials: NK
authors.lastname: Choudhry
authors.forename: Brandon
authors.initials: B
authors.lastname: Zagorski
authors.forename: Jerry
authors.initials: J
authors.lastname: Avorn
authors.forename: Raisa
authors.initials: R
authors.lastname: Levin
authors.forename: Kathy
authors.initials: K
authors.lastname: Sykora
authors.forename: Andreas
authors.initials: A
authors.lastname: Laupacis
authors.forename: Muhammad
authors.initials: M
authors.lastname: Mamdani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians'; D055656:Prescriptions / Q000706:statistics & numerical data*
chemical_list: D000889:Anti-Arrhythmia Agents