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Journal of the American College of Cardiology

Clinical Articles, News & Views

Rhythm versus rate control strategies in AF and CHF

Improvements in quality of life and functional capacity are similar in patients with atrial fibrillation (AF) and coronary heart failure (CHF) randomised to rhythm- versus rate-control strategies, while sinus rhythm was associated with beneficial effects on New York Heart Association (NYHA) functional class and modest gains in quality of life, according to a study1 published recently in the Journal of the American College of Cardiology.

The AF-CHF (Atrial Fibrillation and Congestive Heart Failure) trial randomised 1,376 patients to rhythm- or rate-control strategies. For their pre-specified substudy, researchers administered Medical Outcomes Short Form-36 questionnaires at baseline and four months. Six-minute walk tests were conducted at baseline, three weeks, four months, and one year.

Quality of life improved across all domains to a similar extent with rhythm and rate control. However, a higher proportion of time spent in sinus rhythm was associated with a modestly greater improvement in quality of life scores. Six-min walk distance (p = 0.2328) and NYHA functional class (p = 0.1712) improved to a similar degree with rhythm and rate control. A higher proportion of time spent in sinus rhythm was associated with a greater improvement in NYHA functional class (p < 0.0001) but not in 6-minute walk distance (p = 0.1308).

In an accompanying editorial, Dr Michael Kim (Warren Alpert Medical School of Brown University, Rhode Island, USA) says: “The data from the AF-CHF trial are a welcome addition to the literature because there is a lack of robust data on such outcomes in AF patients with severe heart failure, especially when differentiated by treatment strategy. AF and heart failure will be increasingly linked in the future.”

References

1. Suman-Horduna I, Roy D, Frasure-Smith N, et al. Quality of life and functional capacity in patients with atrial fibrillation and congestive heart failure. J Am Coll Cardiol 2013. http://dx.doi.org/10.1016/j.jacc.2012.10.031

2. Kim MH. Treatment targets in atrial fibrillation: “Is feeling better good enough?”. J Am Coll Cardiol 2013. http://dx.doi.org/10.1016/j.jacc.2012.08.1027

Published on: January 25, 2013

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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