title: Rate-control treatment and mortality in atrial fibrillation.
abstract: BACKGROUND
  Current American and European guidelines emphasize the importance of rate-control treatments in treating atrial fibrillation with a Class I recommendation, although data on the survival benefits of rate control are lacking. The goal of the present study was to investigate whether patients receiving rate-control drugs had a better prognosis compared with those without rate-control treatment.
  
  
  RESULTS
  This study used the National Health Insurance Research Database in Taiwan. There were 43 879, 18 466, and 38 898 patients with atrial fibrillation enrolled in the groups receiving β-blockers, calcium channel blockers, and digoxin, respectively. The reference group consisted of 168 678 subjects who did not receive any rate-control drug. The clinical end point was all-cause mortality. During a follow-up of 4.9±3.7 years, mortality occurred in 88 263 patients (32.7%). After adjustment for baseline differences, the risk of mortality was lower in patients receiving β-blockers (adjusted hazard ratio=0.76; 95% confidence interval=0.74-0.78) and calcium channel blockers (adjusted hazard ratio=0.93; 95% confidence interval=0.90-0.96) compared with those who did not receive rate-control medications. On the contrary, the digoxin group had a higher risk of mortality with an adjusted hazard ratio of 1.12 (95% confidence interval=1.10-1.14). The results were observed consistently in subgroup analyses and among the cohorts after propensity matching.
  
  
  CONCLUSIONS
  In this nationwide atrial fibrillation cohort, the risk of mortality was lower for patients receiving rate-control treatment with β-blockers or calcium channel blockers, and the use of β-blockers was associated with the largest risk reduction. Digoxin use was associated with greater mortality. Prospective, randomized trials are necessary to confirm these findings.
authors.affiliation: From Division of Cardiology, Department of Medicine (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.), Division of Hematology and Oncology, Department of Medicine (C.-J.L.), Division of Infectious Diseases, Department of Medicine (S.-J.C.), Department of Family Medicine (T.-J.C.), General Clinical Research Center (C.E.C.), and Department of Medical Research and Education (C.E.C.), Taipei Veterans General Hospital, Taipei, Taiwan; and Institute of Clinical Medicine and Cardiovascular Research Center (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.) and Institute of Public Health and School of Medicine (C.-J.L., S.-J.C.), National Yang-Ming University, Taipei, Taiwan.
authors.forename: Tze-Fan
authors.initials: TF
authors.lastname: Chao
authors.affiliation: From Division of Cardiology, Department of Medicine (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.), Division of Hematology and Oncology, Department of Medicine (C.-J.L.), Division of Infectious Diseases, Department of Medicine (S.-J.C.), Department of Family Medicine (T.-J.C.), General Clinical Research Center (C.E.C.), and Department of Medical Research and Education (C.E.C.), Taipei Veterans General Hospital, Taipei, Taiwan; and Institute of Clinical Medicine and Cardiovascular Research Center (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.) and Institute of Public Health and School of Medicine (C.-J.L., S.-J.C.), National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chia-Jen
authors.initials: CJ
authors.lastname: Liu
authors.affiliation: From Division of Cardiology, Department of Medicine (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.), Division of Hematology and Oncology, Department of Medicine (C.-J.L.), Division of Infectious Diseases, Department of Medicine (S.-J.C.), Department of Family Medicine (T.-J.C.), General Clinical Research Center (C.E.C.), and Department of Medical Research and Education (C.E.C.), Taipei Veterans General Hospital, Taipei, Taiwan; and Institute of Clinical Medicine and Cardiovascular Research Center (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.) and Institute of Public Health and School of Medicine (C.-J.L., S.-J.C.), National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ta-Chuan
authors.initials: TC
authors.lastname: Tuan
authors.affiliation: From Division of Cardiology, Department of Medicine (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.), Division of Hematology and Oncology, Department of Medicine (C.-J.L.), Division of Infectious Diseases, Department of Medicine (S.-J.C.), Department of Family Medicine (T.-J.C.), General Clinical Research Center (C.E.C.), and Department of Medical Research and Education (C.E.C.), Taipei Veterans General Hospital, Taipei, Taiwan; and Institute of Clinical Medicine and Cardiovascular Research Center (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.) and Institute of Public Health and School of Medicine (C.-J.L., S.-J.C.), National Yang-Ming University, Taipei, Taiwan.
authors.forename: Su-Jung
authors.initials: SJ
authors.lastname: Chen
authors.affiliation: From Division of Cardiology, Department of Medicine (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.), Division of Hematology and Oncology, Department of Medicine (C.-J.L.), Division of Infectious Diseases, Department of Medicine (S.-J.C.), Department of Family Medicine (T.-J.C.), General Clinical Research Center (C.E.C.), and Department of Medical Research and Education (C.E.C.), Taipei Veterans General Hospital, Taipei, Taiwan; and Institute of Clinical Medicine and Cardiovascular Research Center (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.) and Institute of Public Health and School of Medicine (C.-J.L., S.-J.C.), National Yang-Ming University, Taipei, Taiwan.
authors.forename: Kang-Ling
authors.initials: KL
authors.lastname: Wang
authors.affiliation: From Division of Cardiology, Department of Medicine (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.), Division of Hematology and Oncology, Department of Medicine (C.-J.L.), Division of Infectious Diseases, Department of Medicine (S.-J.C.), Department of Family Medicine (T.-J.C.), General Clinical Research Center (C.E.C.), and Department of Medical Research and Education (C.E.C.), Taipei Veterans General Hospital, Taipei, Taiwan; and Institute of Clinical Medicine and Cardiovascular Research Center (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.) and Institute of Public Health and School of Medicine (C.-J.L., S.-J.C.), National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yenn-Jiang
authors.initials: YJ
authors.lastname: Lin
authors.affiliation: From Division of Cardiology, Department of Medicine (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.), Division of Hematology and Oncology, Department of Medicine (C.-J.L.), Division of Infectious Diseases, Department of Medicine (S.-J.C.), Department of Family Medicine (T.-J.C.), General Clinical Research Center (C.E.C.), and Department of Medical Research and Education (C.E.C.), Taipei Veterans General Hospital, Taipei, Taiwan; and Institute of Clinical Medicine and Cardiovascular Research Center (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.) and Institute of Public Health and School of Medicine (C.-J.L., S.-J.C.), National Yang-Ming University, Taipei, Taiwan.
authors.forename: Shih-Lin
authors.initials: SL
authors.lastname: Chang
authors.affiliation: From Division of Cardiology, Department of Medicine (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.), Division of Hematology and Oncology, Department of Medicine (C.-J.L.), Division of Infectious Diseases, Department of Medicine (S.-J.C.), Department of Family Medicine (T.-J.C.), General Clinical Research Center (C.E.C.), and Department of Medical Research and Education (C.E.C.), Taipei Veterans General Hospital, Taipei, Taiwan; and Institute of Clinical Medicine and Cardiovascular Research Center (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.) and Institute of Public Health and School of Medicine (C.-J.L., S.-J.C.), National Yang-Ming University, Taipei, Taiwan.
authors.forename: Li-Wei
authors.initials: LW
authors.lastname: Lo
authors.affiliation: From Division of Cardiology, Department of Medicine (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.), Division of Hematology and Oncology, Department of Medicine (C.-J.L.), Division of Infectious Diseases, Department of Medicine (S.-J.C.), Department of Family Medicine (T.-J.C.), General Clinical Research Center (C.E.C.), and Department of Medical Research and Education (C.E.C.), Taipei Veterans General Hospital, Taipei, Taiwan; and Institute of Clinical Medicine and Cardiovascular Research Center (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.) and Institute of Public Health and School of Medicine (C.-J.L., S.-J.C.), National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yu-Feng
authors.initials: YF
authors.lastname: Hu
authors.affiliation: From Division of Cardiology, Department of Medicine (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.), Division of Hematology and Oncology, Department of Medicine (C.-J.L.), Division of Infectious Diseases, Department of Medicine (S.-J.C.), Department of Family Medicine (T.-J.C.), General Clinical Research Center (C.E.C.), and Department of Medical Research and Education (C.E.C.), Taipei Veterans General Hospital, Taipei, Taiwan; and Institute of Clinical Medicine and Cardiovascular Research Center (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.) and Institute of Public Health and School of Medicine (C.-J.L., S.-J.C.), National Yang-Ming University, Taipei, Taiwan.
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.affiliation: From Division of Cardiology, Department of Medicine (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.), Division of Hematology and Oncology, Department of Medicine (C.-J.L.), Division of Infectious Diseases, Department of Medicine (S.-J.C.), Department of Family Medicine (T.-J.C.), General Clinical Research Center (C.E.C.), and Department of Medical Research and Education (C.E.C.), Taipei Veterans General Hospital, Taipei, Taiwan; and Institute of Clinical Medicine and Cardiovascular Research Center (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.) and Institute of Public Health and School of Medicine (C.-J.L., S.-J.C.), National Yang-Ming University, Taipei, Taiwan. cechiang@vghtpe.gov.tw epsachen@ms41.hinet.net.
authors.forename: Chern-En
authors.initials: CE
authors.lastname: Chiang
authors.affiliation: From Division of Cardiology, Department of Medicine (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.), Division of Hematology and Oncology, Department of Medicine (C.-J.L.), Division of Infectious Diseases, Department of Medicine (S.-J.C.), Department of Family Medicine (T.-J.C.), General Clinical Research Center (C.E.C.), and Department of Medical Research and Education (C.E.C.), Taipei Veterans General Hospital, Taipei, Taiwan; and Institute of Clinical Medicine and Cardiovascular Research Center (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.) and Institute of Public Health and School of Medicine (C.-J.L., S.-J.C.), National Yang-Ming University, Taipei, Taiwan. cechiang@vghtpe.gov.tw epsachen@ms41.hinet.net.
authors.forename: Shih-Ann
authors.initials: SA
authors.lastname: Chen
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D004077:Digoxin / Q000627:therapeutic use*; D004363:Drug Utilization; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D012111:Residence Characteristics; D040242:Risk Reduction Behavior; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants; D002121:Calcium Channel Blockers; D004077:Digoxin
keywords: adrenergic beta antagonists; atrial fibrillation; calcium channel blockers; digoxin; heart rate