title: A Greek Prospective Observational Study of Cardiovascular Morbidity and Mortality in Patients with Atrial Fibrillation.
abstract: BACKGROUND
  Atrial fibrillation (AF) is the most common form of cardiac arrhythmia and represents a growing threat to public health. A representation of data among the private sector in Greece and an assessment of the correlation of different treatment strategies (rate or rhythm control) with annual cardiovascular (CV) morbidity and total mortality, are generally lacking.
  
  
  METHODS
  Patients aged >18 years, diagnosed with AF verified by a standard electrocardiogram (ECG), were included in this observational study (n=1545). Information and data, including demographic characteristics, clinical profiles, therapeutic strategies and outcomes, were collected prospectively from each patient at 4 visits: baseline, 6±2, 12±2, and 24±2 months. Data were analyzed using descriptive statistics, quantitative and qualitative variables.
  
  
  RESULTS
  The annual non-adjusted CV morbidity was 18.1% [95% CI 16.0-20.3%] and 17.2% [13.9-18.4%] in the first and second years, respectively. At the end of the first year, the non-adjusted CV morbidity was 17.1% [14.0-20.3%] for rhythm-control treatment and 18.9% [15.9-21.8%] for rate-control treatment (p=0.477). At the end of the second year, the non-adjusted CV morbidity was 14.9% [11.6-18.2%] for rhythm-control treatment and 17.2% [14.1-20.2%] for rate-control treatment (p=0.367). Overall non-adjusted mortality was 1.6% [0.9-2.3%] and 1.9% [1.1-2.7%] in the first and second years, respectively. At the end of the first year, the non-adjusted mortality was 0.7% [0.02-1.5%] for rhythm-control treatment and 2.3% [1.9-3.4%] for rate-control treatment (p=0.030). At the end of the second year, the non-adjusted mortality was 0.6% [0-1.4%] for rhythm-control treatment and 2.8% [1.5-4.1%] for rate-control treatment (p=0.009).
  
  
  CONCLUSIONS
  In this multi-centre, countrywide, 24-month observational prospective study, there were no statistically significant differences in CV morbidity between rhythm and rate control treatments, whereas there were statistically significant differences in total mortality in the first and second years. Rhythm- versus rate-control treatment showed a lower rate of total mortality in both the first and second years.
authors.affiliation: Cardiology Department, Heraklion University Hospital, Heraklion, Crete, Greece.
authors.forename: Panos
authors.initials: P
authors.lastname: Vardas
authors.forename: George
authors.initials: G
authors.lastname: Andrikopoulos
authors.forename: Barbara
authors.initials: B
authors.lastname: Baroutsou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology / Q000401:mortality; D004554:Electric Countershock / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005500:Follow-Up Studies; D006115:Greece / Q000453:epidemiology; D006325:Heart Atria / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D015994:Incidence; D009017:Morbidity; D015995:Prevalence; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants