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IMPACT OF RHYTHM VERSUS RATE CONTROL FOR PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE AND ATRIAL FIBRILLATION OR FLUTTER
Journal article   Open access   Peer reviewed

IMPACT OF RHYTHM VERSUS RATE CONTROL FOR PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE AND ATRIAL FIBRILLATION OR FLUTTER

Lee Joseph, Abraham Sonny, Somnath Bose, Prashant Bhave, Michael Giudici and Mary S Vaughan-Sarrazin
Journal of the American College of Cardiology, Vol.67(13), pp.847-847
04/2016
DOI: 10.1016/S0735-1097(16)30848-8
url
https://doi.org/10.1016/S0735-1097(16)30848-8View
Published (Version of record) Open Access

Abstract

Background Previous studies suggest similar outcomes using rate or rhythm control to manage atrial fibrillation or atrial flutter (AF/AFL) in patients with chronic heart failure. However, little is known about the efficacy of these strategies in patients hospitalized for acute decompensated heart failure (ADHF). Objectives To compare mortality associated with rhythm control (electrical or pharmacological) versus rate control for managing AF/AFL in patients with ADHF. Methods We identified 8,017 patients with ADHF and AF/AFL who were admitted to Veterans Affairs (VA) hospitals during fiscal years 2010-2013 using VA administrative data files. We used marginal structural models to compare in-hospital mortality for patients receiving rate plus rhythm control, versus rate control only, while treating receipt of each treatment as time-dependent over the course of the admission. Models also controlled for baseline pulse, demographics, comorbid conditions, medication history and time-dependent pulse. We also separately analyzed patients with pulse at admission >=100 beats per minute (bpm). Results Overall, 70% of patients were white; mean age was 74.1 (±10.8), and 30% had heart rate >100 bpm at admission. Nearly all (92%) patients received rate control during the admission, while 17% received rhythm control. In unadjusted analyses, patients receiving rhythm control had significantly higher mortality compared to patients without rhythm control (3.9% versus 2.5%; p=0.002). In risk adjusted marginal structural models, receipt of rhythm plus rate control was not significantly associated with in-hospital mortality, relative to rate control only [OR (95% CI) = 1.14 (0.76-1.69); p=0.53]. However, analysis stratified by baseline pulse suggested a trend towards improved survival with rhythm control among patients with pulse ≥ 100 bpm compared to those with pulse < 100 bpm [OR (95% CI), 0.68 (0.32-1.42); p=0.30 vs. OR (95% CI), 1.37 (0.86-2.18); p=0.19]. Conclusions Managing AF/AFL in patients with ADHF using rhythm control does not significantly impact survival over rate control alone. The use of rhythm control in patients with tachycardia may be beneficial and warrants further study.

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