Abstract 3234: Patterns of Treatment of Patients with Atrial Fibrillation
Background: Atrial fibrillation (AF) is increasingly common, and a number of treatment options are available. Since trials such as AFFIRM show no mortality difference between rate or rhythm control strategies, we hypothesized that rate control would become more common with increased duration of AF.
Methods: We evaluated history of treatment modalities in 1052 patients with AF referred to a dedicated AF center. 472 had AF for ≥ 5 years and 200 for ≥ 10 years. We recorded AF symptom burden, calculated as the product of frequency and duration of episodes, and treatment history from first AF episode using a database modeled on AHA-recommended key data elements.
Results: The median (25th, 75th percentiles) AF duration was 4.5 (2, 9) years. The median symptom burden was 28% in the first year after symptoms started, and fluctuated from 10 to 15% thereafter. 37% had a CHADS2 score 0, 43% had score 1, and 20% had score ≥ 2. Anti-thrombotic use was near 40%. The Figure⇓ shows the spectrum of drug use. In the first year, rate control drugs (blue bars) were used 2.5 fold more commonly than AAD. Surprisingly, the use of anti-arrhythmic drugs (AAD) increased with duration of AF and after five years, they were nearly equal. 20% of patients had cardioversion in the first year, 3% in the second, and 1% or less for year 5 and after. 60% of all cardioversions were performed in the first year of symptoms.
Conclusion: Cardioversion is more common during the first year of AF. In subsequent years, symptom burden falls and is relatively stable. AAD usage increases while rate control use remains constant. This suggests that physicians may continue to use AAD drugs to help control symptoms.