Rate-control versus rhythm-control strategies and outcomes in septuagenarians with atrial fibrillation.
BACKGROUND
The prevalence of atrial fibrillation substantially increases after 70 years of age. However, the effect of rate-control versus rhythm-control strategies on outcomes in these patients remains unclear.


METHODS
In the randomized Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial, 4060 patients (mean age 70 years, range 49-80 years) with paroxysmal and persistent atrial fibrillation were randomized to rate-control versus rhythm-control strategies. Of these, 2248 were 70-80 years, of whom 1118 were in the rate-control group. Propensity scores for rate-control strategy were estimated for each of the 2248 patients and were used to assemble a cohort of 937 pairs of patients receiving rate-control versus rhythm-control strategies, balanced on 45 baseline characteristics.


RESULTS
Matched patients had a mean age of 75 years; 45% were women, 7% were nonwhite, and 47% had prior hospitalizations due to arrhythmias. During 3.4 years of mean follow-up, all-cause mortality occurred in 18% and 23% of matched patients in the rate-control and rhythm-control groups, respectively (hazard ratio [HR] associated with rate control, 0.77; 95% confidence interval [CI], 0.63-0.94; P = .010). HRs (95% CIs) for cardiovascular and noncardiovascular mortality associated with rate control were 0.88 (0.65-1.18) and 0.62 (0.46-0.84), respectively. All-cause hospitalization occurred in 61% and 68% of rate-control and rhythm-control patients, respectively (HR 0.76; 95% CI, 0.68-0.86). HRs (95% CIs) for cardiovascular and noncardiovascular hospitalization were 0.66 (0.56-0.77) and 1.07 (0.91-1.27), respectively.


CONCLUSIONS
In septuagenarian patients with atrial fibrillation, compared with rhythm-control, a rate-control strategy was associated with significantly lower mortality and hospitalization.
University of Pittsburgh, Pittsburgh, Pa.
Nasir
N
Shariff
Ravi V
RV
Desai
Kanan
K
Patel
Mustafa I
MI
Ahmed
Gregg C
GC
Fonarow
Michael W
MW
Rich
Inmaculada B
IB
Aban
Maciej
M
Banach
Thomas E
TE
Love
Michel
M
White
Wilbert S
WS
Aronow
Andrew E
AE
Epstein
Ali
A
Ahmed
D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D015331:Cohort Studies; D004554:Electric Countershock; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D057216:Propensity Score; D016016:Proportional Hazards Models; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents
Atrial fibrillation; Hospitalization; Mortality; Older adults; Propensity score; Rate control; Rhythm control