Abstract 2029: The Selection Of A Rate Versus Rhythm Control Strategy For Atrial Fibrillation Management Following AFFIRM And RACE
Introduction: Both AFFIRM and RACE reported no survival difference in atrial fibrillation (AF) patients (pt) managed by a rate control (RaC) versus a rhythm control (RhC) strategy using our current treatment (Rx) options. Treatment implications ensued. However, pt enrolled in these trials were predominantly those with underlying disorders placing them at high risk for stroke and other serious adverse events. How physicians have interpreted the results of these trials as they apply to the substantial number of lower risk AF pt that are encountered has not yet been determined.
Methods: To determine the management strategy (MS) now applied to lower risk pt with AF, subsequent to AFFIRM and RACE, we examined the MS used in the large AFFECTS Registry. AFFECTS is an ongoing observational study of (a) the Rx patterns of 248 practicing U.S. cardiologists who were directly exposed to the 2001 ACC/AHA/ESC AF management guidelines subsequent to AFFIRM and RACE, and, (b) the Rx outcomes in the 1535 AF pt enrolled (predominantly having no or minimal structural heart disease or uncomplicated hypertension) which began enrolling pt in May 2005 and followed them for 1 year.
Results: In the 902 pt with evaluable data as of the Sept’06 planned interim analysis [55.4% male, age 66.3 +/− 13.1 yrs, 39% <age 65, 14.4%>79 yrs], RhC was chosen as the primary MS in 587 pt (65%) and RaC in 35%. This was unaffected by gender, age, ethnicity, or a history of recurrent versus new AF. RhC was chosen more often than RaC in both persistent AF (54% vs 46%) and paroxysmal AF (67% vs 33%). However, RhC was chosen less often than RaC in pt with a longer history of AF (mean/median 21.15/2.4 months versus 31.73/6.3 months) and markedly less in pt with an AF duration of 1 year or more versus <3 months (58% vs 72%).
Conclusions: It appears that practicing U.S. cardiologists are currently choosing RhC as a MS more often that RaC in non-high risk AF pt, as reflected by this interim AFFECTS Registry analysis – especially with a recent versus protracted AF history. AFFIRM and RACE do not appear to have suppressed the belief that sinus rhythm and antiarrhythmic drug use may benefit the majority of pt with neither chronic AF nor high risk markers.