title: Real-life observations of clinical outcomes with rhythm- and rate-control therapies for atrial fibrillation RECORDAF (Registry on Cardiac Rhythm Disorders Assessing the Control of Atrial Fibrillation).
abstract: OBJECTIVE
  RECORDAF is the first worldwide, prospective, observational survey of management of atrial fibrillation (AF) in unselected, community-based patients.
  
  
  BACKGROUND
  Primary outcomes were therapeutic success and clinical outcomes associated with rhythm-control and rate-control strategies.
  
  
  METHODS
  Patients with recent-onset AF were included (n = 5,604). Treatment strategy (rhythm control or rate control) was noted at baseline. Follow-up was 12 months. Therapeutic success required that strategy was unchanged without clinical events. Further maintenance of sinus rhythm was required in the rhythm-control group, and heart rate ≤80 beats/min in the rate-control group.
  
  
  RESULTS
  Data from 5,171 patients were assessable. Therapeutic success was 54% overall (rhythm control 60% vs. rate control 47%), a result driven by control of AF: rhythm control, 81% vs. rate control, 74%. After adjustment for propensity score quintiles, the rhythm-control strategy was significantly related to superior therapeutic success (odds ratio: 1.34, 95% confidence interval: 1.15 to 1.55; p = 0.0002). Clinical events occurred in 18% of patients. The arrhythmia management strategy was not predictive of clinical events. The type (persistent), presence at baseline visit, and duration (>3 months) of AF, together with age older than 75 years and the presence of heart failure, predicted progression to permanent AF. The choice of rhythm control reduced the likelihood of AF progression (odds ratio: 0.20, 95% confidence interval: 0.17 to 0.25; p < 0.0001).
  
  
  CONCLUSIONS
  Clinical outcomes in AF patients were driven mainly by hospitalizations for arrhythmia/proarrhythmia and other cardiovascular causes, but not by the choice of rate or rhythm strategy. Rhythm-control patients progressed less rapidly to permanent AF.
authors.affiliation: St. George's University of London, Cranmer Terrace, London, United Kingdom. jcamm@sgul.ac.uk.
authors.forename: A John
authors.initials: AJ
authors.lastname: Camm
authors.forename: Günter
authors.initials: G
authors.lastname: Breithardt
authors.forename: Harry
authors.initials: H
authors.lastname: Crijns
authors.forename: Paul
authors.initials: P
authors.lastname: Dorian
authors.forename: Peter
authors.initials: P
authors.lastname: Kowey
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Le Heuzey
authors.forename: Ihsen
authors.initials: I
authors.lastname: Merioua
authors.forename: Laurence
authors.initials: L
authors.lastname: Pedrazzini
authors.forename: Eric N
authors.initials: EN
authors.lastname: Prystowsky
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Schwartz
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.forename: William
authors.initials: W
authors.lastname: Weintraub
mesh_terms: D000367:Age Factors; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000628:therapy*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D002301:Cardiac Glycosides / Q000627:therapeutic use; D017115:Catheter Ablation; D018450:Disease Progression; D004554:Electric Countershock; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000145:classification / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D010138:Pacemaker, Artificial; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control; D013997:Time Factors; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000889:Anti-Arrhythmia Agents; D002121:Calcium Channel Blockers; D002301:Cardiac Glycosides; D010975:Platelet Aggregation Inhibitors; D014812:Vitamin K