title: Rate versus rhythm control for management of atrial fibrillation in clinical practice: results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry.
abstract: BACKGROUND
  All patients with atrial fibrillation (AF) require optimization of their ventricular rate. Factors leading to use of additional rhythm control in clinical practice have not been thoroughly defined.
  
  
  METHODS
  The ORBIT-AF registry enrolled patients with AF from a broad range of practice settings and collected data on rate versus rhythm control, as indicated by the treating physician. Multivariable logistic regression analysis was performed to identify factors associated with each strategy.
  
  
  RESULTS
  Of 10,061 patients enrolled, 6,859 (68%) were managed with rate only control versus 3,202 (32%) with rhythm control. Patients managed with rate control were significantly older and more likely to have hypertension, heart failure, prior stroke, and gastrointestinal bleeds. They also had fewer AF-related symptoms (41% with no symptoms vs 31% for rhythm control). Systemic anticoagulation was prescribed for 5,448 (79%) rate-control patients versus 2,219 (69%) rhythm-control patients (P < .0001). After multivariable adjustment, patients with higher symptom scores (severe symptoms vs. none, OR 1.62, 95% CI 1.41-1.87) and those referred to electrophysiologists (OR 1.64, 95% CI 1.45-1.85) were more likely to be managed with a rhythm control strategy.
  
  
  CONCLUSIONS
  In this outpatient registry of US clinical practice, the majority of patients with AF were managed with rate control alone. Patients with more symptoms and who were treated by an electrophysiologist were more likely to receive rhythm-control therapies. A significant proportion of AF patients, regardless of treatment strategy, were not treated with anticoagulation for thromboembolism prophylaxis.
authors.affiliation: Duke University Medical Center, Durham, NC 27715, USA. benjamin.steinberg@duke.edu
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Steinberg
authors.forename: DaJuanicia N
authors.initials: DN
authors.lastname: Holmes
authors.forename: Michael D
authors.initials: MD
authors.lastname: Ezekowitz
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: Peter R
authors.initials: PR
authors.lastname: Kowey
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Mahaffey
authors.forename: Gerald
authors.initials: G
authors.lastname: Naccarelli
authors.forename: James
authors.initials: J
authors.lastname: Reiffel
authors.forename: Paul
authors.initials: P
authors.lastname: Chang
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Piccini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012042:Registries; D013923:Thromboembolism / Q000517:prevention & control
chemical_list: D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants
references.citation: Am J Cardiol. 2010 Apr 15;105(8):1122-9
references.pmid: 20381664
references.citation: Circulation. 2011 Mar 15;123(10):e269-367
references.pmid: 21382897
references.citation: Int J Cardiol. 2013 May 25;165(3):430-6
references.pmid: 21917326
references.citation: Am Heart J. 2011 Oct;162(4):606-612.e1
references.pmid: 21982650
references.citation: Heart. 2012 Feb;98(3):195-201
references.pmid: 21948959
references.citation: Circulation. 2004 Apr 27;109(16):1973-80
references.pmid: 15051639
references.citation: N Engl J Med. 2012 Jan 12;366(2):120-9
references.pmid: 22236222
references.citation: N Engl J Med. 2008 Jun 19;358(25):2667-77
references.pmid: 18565859
references.citation: J Am Coll Cardiol. 2011 Nov 1;58(19):1975-85
references.pmid: 22032709
references.citation: Eur Heart J. 2008 May;29(9):1181-9
references.pmid: 18397874
references.citation: Am Heart J. 2005 Jan;149(1):112-20
references.pmid: 15660042
references.citation: Heart Rhythm. 2010 May;7(5):596-601
references.pmid: 20159046
references.citation: Am J Cardiol. 2006 Feb 15;97(4):538-43
references.pmid: 16461052
references.citation: Circulation. 2012 Dec 4;126(23):2680-7
references.pmid: 23124034
references.citation: J Am Coll Cardiol. 2011 Jul 26;58(5):493-501
references.pmid: 21777747
references.citation: Eur Heart J. 2006 Dec;27(24):3018-26
references.pmid: 16731536
references.citation: Eur Heart J. 2005 Nov;26(22):2422-34
references.pmid: 16204266
references.citation: J Am Coll Cardiol. 2005 Nov 15;46(10):1891-9
references.pmid: 16286177
references.citation: Arch Intern Med. 2012 Jul 9;172(13):997-1004
references.pmid: 22664954