Chung Ho-Gi, Park Junbeom, Park Jin-Kyu, Kang Ki-Woon, Shim Jaemin, Kim Jin-Bae, Kim Jun, Choi Eue-Keun, Park Hyung Wook, Lee Young Soo, Joung Boyoung
Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonseiro, Seodaemun-gu, Seoul 03722, Republic of Korea.
Department of Cardiology, School of Medicine, Ewha Womans University, Seoul 07985, Republic of Korea.
J Clin Med. 2023 Jul 10;12(14):4579. doi: 10.3390/jcm12144579.
It is not clear whether the data regarding rhythm control during atrial fibrillation (AF) contained in AF registries is prognostically significant. Thus, this study investigated the relationship between rhythm control and cardiovascular outcomes in patients in contemporary AF registries.
This study was conducted using data from 6670 patients with AF receiving oral anticoagulation in the CODE-AF registry. We used propensity overlap weighting to account for differences in baseline characteristics between the rhythm control and rate control groups. The primary outcome was a composite of the rate of death due to cardiovascular causes, stroke, acute coronary syndrome, and heart failure. The secondary outcomes were individual components of the primary outcome.
In the CODE-AF registry, 5407 (81.1%) patients were enrolled three months after AF diagnosis. During a median follow-up period of 973 days (interquartile range: 755-1089 days), a primary outcome event occurred in 72 patients in the rhythm control group (1.4 events per 100 person-years) and in 211 patients in the rate control group (1.8 events per 100 person-years). However, after overlap weighting, the incidence rates were 1.4 and 1.5 events per 100 person-years, respectively. No significant difference was found in either the primary outcome (weighted HR: 0.87; 95% CI: 0.66-1.17; = 0.363) or secondary outcomes between the rhythm control and rate control groups.
In a prospective AF registry in which most of the population was enrolled at least three months after AF diagnosis, no difference in the risk of cardiovascular or cerebrovascular outcomes was found between the rhythm control and rate control groups, suggesting the early rhythm control should be considered to improve the outcome of patients.
心房颤动（AF）注册研究中包含的关于房颤期间节律控制的数据在预后方面是否具有重要意义尚不清楚。因此，本研究调查了当代房颤注册研究中患者节律控制与心血管结局之间的关系。
本研究使用了来自CODE-AF注册研究中6670例接受口服抗凝治疗的房颤患者的数据。我们使用倾向重叠加权法来考虑节律控制组和心率控制组之间基线特征的差异。主要结局是心血管原因导致的死亡、中风、急性冠状动脉综合征和心力衰竭发生率的综合指标。次要结局是主要结局的各个组成部分。
在CODE-AF注册研究中，5407例（81.1%）患者在房颤诊断后3个月入组。在中位随访期973天（四分位间距：755-1089天）内，节律控制组有72例患者发生主要结局事件（每100人年1.4例事件），心率控制组有211例患者发生主要结局事件（每100人年1.8例事件）。然而，经过重叠加权后，发生率分别为每100人年1.4例和1.5例事件。节律控制组和心率控制组在主要结局（加权HR：0.87；95%CI：0.66-1.17；P = 0.363）或次要结局方面均未发现显著差异。
在一项前瞻性房颤注册研究中，大多数患者在房颤诊断后至少3个月入组，节律控制组和心率控制组在心血管或脑血管结局风险方面未发现差异，这表明应考虑早期节律控制以改善患者结局。
