Abstract 2866: Factors Associated with Rhythm versus Rate Control Strategies in Hospitalized Patients with Atrial Fibrillation
Background: Amidst the debate on whether the rhythm control or rate control strategy is best for patients with atrial fibrillation (AF), little is known about which strategy is primarily used in clinical practice. We evaluated the use of each strategy and identified factors associated with rhythm vs. rate control.
Methods: Using Premier’s Perspective Database, a clinical and financial information system of participating US hospitals, the first hospital discharge for each adult patient with a primary diagnosis of AF from 1/1/00 to 12/31/04 was identified. In hospital AF management was categorized as rhythm control in patients with antiarrhythmic drugs (AAD), ablation or cardioversion. AF management was categorized as rate control if beta-blockers, calcium channel blockers (CCB), or digoxin were administered without use of AAD, ablation, or cardioversion. Factors associated with rhythm vs. rate control were determined using a logistic regression model accounting for hospital clustering.
Results: The study cohort included 179,427 hospital discharges from 464 hospitals. Median age was 72 (IQR 61, 80) and 54.2% were women, 4.8% had rheumatic heart disease, 7% had atrial flutter, and 3% had cardiac surgery during hospitalization. A total of 91,889 (51.2%) were in the rhythm control group of which 93% received an AAD, 5% ablation, 27% cardioversion, and 83% a rate controlling drug. CCB were the most frequently used rate control drugs in both groups; 52% in rhythm control group and 67% in rate control group. Baseline factors associated with rhythm vs. rate control are in the Table⇓.
Conclusion: The use of rhythm and rate control strategies were approximately equal, but there was a trend towards decreased use of rhythm control over time. Even after adjustment for clinical factors, being cared for by a cardiologist increased the odds of getting the rhythm control strategy by 3 fold. Studies are needed to better determine which strategy is most appropriate for an individual patient.