Clinical factors associated with abandonment of a rate-control or a rhythm-control strategy for the management of atrial fibrillation in the AFFIRM study

The objective of the current study was to determine the clinical factors that were associated with abandonment of a rate-control or a rhythm-control strategy in patients with atrial fibrillation (AF). Although the AFFIRM Study demonstrated that outcomes are similar with a primary strategy of rate-co...

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Published in:The American heart journal 2005-02, Vol.149 (2), p.304-308
Main Authors: Curtis, Anne B., Seals, A. Allen, Safford, Robert E., Slater, William, Tullo, Nicholas G., Vidaillet, Humberto, Wilber, David J., Slee, April
Format: Article
Language:English
Subjects:
Age Factors
Aged
Anti-Arrhythmia Agents - therapeutic use
Atrial Fibrillation - mortality
Atrial Fibrillation - physiopathology
Atrial Fibrillation - therapy
Biological and medical sciences
Cardiac arrhythmia
Cardiac dysrhythmias
Cardiology. Vascular system
Cardiovascular disease
Drug therapy
Electric Countershock
Female
Follow-Up Studies
Heart
Heart attacks
Heart Rate
Humans
Male
Medical sciences
Proportional Hazards Models
Substance abuse treatment
Thyroid diseases
Variables
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container_title The American heart journal
container_volume 149
creator Curtis, Anne B.
Seals, A. Allen
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Slater, William
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Wilber, David J.
Slee, April
description The objective of the current study was to determine the clinical factors that were associated with abandonment of a rate-control or a rhythm-control strategy in patients with atrial fibrillation (AF). Although the AFFIRM Study demonstrated that outcomes are similar with a primary strategy of rate-control or rhythm-control for AF, there may be clinical or demographic factors associated with abandonment of the initial treatment strategy. Knowledge of these risk factors would be useful so that patients may be given appropriate initial therapy and, as appropriate, switched to alternative treatments earlier. Patients in the AFFIRM Study were subdivided into those who were maintained on their initial treatment strategy versus those who abandoned initial treatment strategy for alternative therapies. We determined the clinical and demographic factors associated with change in initial treatment strategy. At 5 years the original treatment strategy was maintained in 85% of the patients in the rate-control arm versus 62% of those in the rhythm-control arm ( P
doi_str_mv 10.1016/j.ahj.2004.08.012
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Allen ; Safford, Robert E. ; Slater, William ; Tullo, Nicholas G. ; Vidaillet, Humberto ; Wilber, David J. ; Slee, April</creator><creatorcontrib>Curtis, Anne B. ; Seals, A. Allen ; Safford, Robert E. ; Slater, William ; Tullo, Nicholas G. ; Vidaillet, Humberto ; Wilber, David J. ; Slee, April ; the AFFIRM Investigators</creatorcontrib><description>The objective of the current study was to determine the clinical factors that were associated with abandonment of a rate-control or a rhythm-control strategy in patients with atrial fibrillation (AF). Although the AFFIRM Study demonstrated that outcomes are similar with a primary strategy of rate-control or rhythm-control for AF, there may be clinical or demographic factors associated with abandonment of the initial treatment strategy. Knowledge of these risk factors would be useful so that patients may be given appropriate initial therapy and, as appropriate, switched to alternative treatments earlier. 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Allen</creatorcontrib><creatorcontrib>Safford, Robert E.</creatorcontrib><creatorcontrib>Slater, William</creatorcontrib><creatorcontrib>Tullo, Nicholas G.</creatorcontrib><creatorcontrib>Vidaillet, Humberto</creatorcontrib><creatorcontrib>Wilber, David J.</creatorcontrib><creatorcontrib>Slee, April</creatorcontrib><creatorcontrib>the AFFIRM Investigators</creatorcontrib><title>Clinical factors associated with abandonment of a rate-control or a rhythm-control strategy for the management of atrial fibrillation in the AFFIRM study</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>The objective of the current study was to determine the clinical factors that were associated with abandonment of a rate-control or a rhythm-control strategy in patients with atrial fibrillation (AF). Although the AFFIRM Study demonstrated that outcomes are similar with a primary strategy of rate-control or rhythm-control for AF, there may be clinical or demographic factors associated with abandonment of the initial treatment strategy. Knowledge of these risk factors would be useful so that patients may be given appropriate initial therapy and, as appropriate, switched to alternative treatments earlier. Patients in the AFFIRM Study were subdivided into those who were maintained on their initial treatment strategy versus those who abandoned initial treatment strategy for alternative therapies. We determined the clinical and demographic factors associated with change in initial treatment strategy. At 5 years the original treatment strategy was maintained in 85% of the patients in the rate-control arm versus 62% of those in the rhythm-control arm ( P &lt;.0001). Length of the qualifying episode of AF was associated with abandonment of both rhythm-control and rate-control strategies. 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Allen</au><au>Safford, Robert E.</au><au>Slater, William</au><au>Tullo, Nicholas G.</au><au>Vidaillet, Humberto</au><au>Wilber, David J.</au><au>Slee, April</au><aucorp>the AFFIRM Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical factors associated with abandonment of a rate-control or a rhythm-control strategy for the management of atrial fibrillation in the AFFIRM study</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2005-02-01</date><risdate>2005</risdate><volume>149</volume><issue>2</issue><spage>304</spage><epage>308</epage><pages>304-308</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><coden>AHJOA2</coden><abstract>The objective of the current study was to determine the clinical factors that were associated with abandonment of a rate-control or a rhythm-control strategy in patients with atrial fibrillation (AF). Although the AFFIRM Study demonstrated that outcomes are similar with a primary strategy of rate-control or rhythm-control for AF, there may be clinical or demographic factors associated with abandonment of the initial treatment strategy. Knowledge of these risk factors would be useful so that patients may be given appropriate initial therapy and, as appropriate, switched to alternative treatments earlier. Patients in the AFFIRM Study were subdivided into those who were maintained on their initial treatment strategy versus those who abandoned initial treatment strategy for alternative therapies. We determined the clinical and demographic factors associated with change in initial treatment strategy. At 5 years the original treatment strategy was maintained in 85% of the patients in the rate-control arm versus 62% of those in the rhythm-control arm ( P &lt;.0001). Length of the qualifying episode of AF was associated with abandonment of both rhythm-control and rate-control strategies. Antiarrhythmic drug failure before randomization and a history of thyroid disease also were associated with abandonment of rhythm-control. Patients were more likely to maintain rate-control if they already had an implanted pacemaker or if they were older than 75 years, while an ejection fraction &lt;30% was associated with abandonment of the rate-control strategy. In patients with AF, rhythm-control strategies are abandoned significantly more often than rate-control strategies. Patients with long durations of AF on presentation or previous antiarrhythmic drug failure might be considered for rate-control as initial treatment. (Am Heart J 2005;149:304-8.)</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>15846269</pmid><doi>10.1016/j.ahj.2004.08.012</doi><tpages>5</tpages></addata></record>
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source ScienceDirect Journals
subjects Age Factors
Aged
Anti-Arrhythmia Agents - therapeutic use
Atrial Fibrillation - mortality
Atrial Fibrillation - physiopathology
Atrial Fibrillation - therapy
Biological and medical sciences
Cardiac arrhythmia
Cardiac dysrhythmias
Cardiology. Vascular system
Cardiovascular disease
Drug therapy
Electric Countershock
Female
Follow-Up Studies
Heart
Heart attacks
Heart Rate
Humans
Male
Medical sciences
Proportional Hazards Models
Substance abuse treatment
Thyroid diseases
Variables
title Clinical factors associated with abandonment of a rate-control or a rhythm-control strategy for the management of atrial fibrillation in the AFFIRM study
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