Published online before print March 29, 2004, doi: 10.1161/01.CIR.0000118472.77237.FA
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(Circulation. 2004;109:1973-1980.)
© 2004 American Heart Association, Inc.
Clinical Investigation and Reports |
Analysis of Cause-Specific Mortality in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Study
From St Luke’s–Roosevelt Hospital Center and Columbia University, New York, NY (J.S.S.); Miriam Hospital, Providence, RI (A.S.); Oregon Health Sciences University, Portland (J.K.); London Health Sciences Center, London, Ontario, Canada (A.K.); River Cities Cardiology, Jeffersonville, Ind (D.M.D.); University of Rochester, Rochester, NY (J.D.); St Thomas Hospital, Nashville, Tenn (W.B.C.); Denver General Hospital, Denver, Colo (E.H.); Vanderbilt University, Nashville, Tenn (K.M.); University of Iowa, Iowa City (B.O.); Sutter Institute for Medical Research, Sacramento, Calif (G.O.); Royal Victoria Hospital, Montreal, Quebec, Canada (M.S.); West Virginia University Hospital, Morgantown (S.S.); Geisinger Medical Center, Danville, Pa (R.S.); University of Texas Health Science Center, San Antonio (M.Z.); Krannert Institute of Cardiology, Indianapolis, Ind (J.M.); and Axio Research Corp, Seattle, Wash (M.C., E.M.N., H.L.G.).
Correspondence to Jonathan S. Steinberg, MD, Division of Cardiology, St Luke’s–Roosevelt Hospital Center, 1111 Amsterdam Ave, New York, NY 10025. E-mail jss7{at}columbia.edu
Received September 30, 2003; revision received December 3, 2003; accepted December 5, 2003.
Background— Expectations that reestablishing and maintaining sinus rhythm in patients with atrial fibrillation might improve survival were disproved in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. This report describes the cause-specific modes of death in the AFFIRM treatment groups.
Methods and Results— All deaths in patients enrolled in AFFIRM underwent blinded review by the AFFIRM Events Committee, and a mode of death was assigned. In AFFIRM, 2033 patients were randomized to a rhythm-control strategy and 2027 patients to a rate-control strategy. During a mean follow-up of 3.5 years, there were 356 deaths in the rhythm-control patients and 310 deaths in the rate-control patients (P=0.07). In the rhythm-control group, 129 patients (9%) died of a cardiac cause, and in the rate-control group, 130 patients (10%) died (P=0.95). Both groups had similar rates of arrhythmic and nonarrhythmic cardiac deaths. The numbers of vascular deaths were similar in the 2 groups: 35 (3%) in the rhythm-control group and 37 (3%) in the rate-control group (P=0.82). There were no differences in the rates of ischemic stroke and central nervous system hemorrhage. In the rhythm-control group, there were 169 noncardiovascular deaths (47.5% of the total number of deaths), whereas in the rate-control arm, there were 113 noncardiovascular deaths (36.5% of the total number of deaths) (P=0.0008). Differences in noncardiovascular death rates were due to pulmonary and cancer-related deaths.
Conclusions— Management of atrial fibrillation with a rhythm-control strategy conferred no advantage over a rate-control strategy in cardiac or vascular mortality and may be associated with an increased noncardiovascular death rate.
Key Words: atrium • fibrillation • antiarrhythmia agents • survival
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