Bush David, Martin Lisa W, Leman Robert, Chandler Mary, Haywood L Julian
Johnkins Bayview Medical Center, Baltimore, Maryland, USA.
J Natl Med Assoc. 2006 Mar;98(3):330-9.
The Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study concluded that rate control with anticoagulation was equivalent overall to rhythm control with cardioversion for long-term survival and that anticoagulation reduced the risk of stroke. We compared baseline and follow-up data for three ethnic groups: Caucasians (n=3,599), African Americans (n=265) and Hispanics (n=132). Caucasians were older and more likely male, African Americans were more likely female and hypertensive, and Hispanics had higher prevalence of cardiomyopathy. Survival was better for rate control than rhythm control in Caucasians, equivalent in African Americans and better for rhythm control in Hispanics. Outcomes may be influenced by differential baseline characteristics, but low numbers of African Americans and Hispanics warrant caution in data interpretation.
The AFFIRM study compared a rate-control strategy to a rhythm-control strategy for the treatment of atrial fibrillation (AF) in patients at high risk for stroke or death. It concluded that the rhythm-control strategy offered no survival advantage, and it also confirmed the value of anticoagulation to prevent complications of AF. Data have not previously been available for specific racial ethnic populations.
We compared baseline and follow-up data for the patients randomized to rate-control versus rhythm-control in three population groups-Caucasian, African-American and Hispanic.
Among 4,060 total patients, 3,599 were Caucasian, 265 were African-American and 132 were Hispanic. At baseline, Caucasians were older and had a higher percentage of males, normal ejection fractions, AF as their only cardiac diagnosis, a prior antiarrhythmic drug failure and less congestive heart failure. African Americans were more likely to be female, had more hypertension and qualified for the study with a first episode of AF, compared to Caucasians. Hispanics had more cardiomyopathy at baseline than Caucasians. Overall survival in Caucasians at five years for the rate-control and rhythm-control groups was 78.9% vs. 76.4%, respectively (p=0.04); for African Americans, 79.0% vs. 69.4% (p=0.22); and for Hispanics, 66.5% vs. 83.9% (p=0.01). Overall, survival was not different between the three populations. However, lower rates of event-free survival were recorded for Hispanics and for African Americans (p=0.0182).
Different survival rates were found for rate-control versus rhythm-control in African-American and Hispanic patients, compared to Caucasian. These findings may be influenced by differences in baseline characteristics, but must be interpreted with caution because of the small sample sizes for African-American and Hispanic participants.
心房颤动节律管理随访调查（AFFIRM）研究得出结论，对于长期生存而言，抗凝的心率控制总体上等同于电复律的节律控制，且抗凝可降低中风风险。我们比较了三个种族群体的基线和随访数据：白种人（n = 3599）、非裔美国人（n = 265）和西班牙裔（n = 132）。白种人年龄更大且男性比例更高，非裔美国人女性比例更高且患有高血压，西班牙裔心肌病患病率更高。白种人心率控制组的生存率高于节律控制组，非裔美国人两组相当，西班牙裔节律控制组的生存率更高。结果可能受不同基线特征影响，但非裔美国人和西班牙裔人数较少，在数据解读时需谨慎。
AFFIRM研究比较了心率控制策略与节律控制策略对中风或死亡高危患者心房颤动（AF）的治疗效果。研究得出结论，节律控制策略无生存优势，同时也证实了抗凝预防AF并发症的价值。此前尚无针对特定种族人群的数据。
我们比较了随机分为心率控制组和节律控制组的三个群体（白种人、非裔美国人和西班牙裔）患者的基线和随访数据。
在4060例患者中，3599例为白种人，265例为非裔美国人，132例为西班牙裔。基线时，白种人年龄更大，男性比例更高，射血分数正常，AF为唯一心脏诊断，曾有抗心律失常药物治疗失败经历，且充血性心力衰竭较少。与白种人相比，非裔美国人女性比例更高，高血压更多，且因AF首发事件符合研究标准。西班牙裔基线时心肌病比白种人更多。白种人心率控制组和节律控制组五年总体生存率分别为78.9%和76.4%（p = 0.04）；非裔美国人为79.0%和69.4%（p = 0.22）；西班牙裔为66.5%和83.9%（p = 0.01）。总体而言，三个群体的生存率无差异。然而，西班牙裔和非裔美国人无事件生存率较低（p = 0.0182）。
与白种人相比，非裔美国人和西班牙裔患者心率控制与节律控制的生存率不同。这些发现可能受基线特征差异影响，但由于非裔美国人和西班牙裔参与者样本量较小，必须谨慎解读。
