Study examines comparative effectiveness of rhythm control vs. rate control drug treatment

June 4, 2012, JAMA and Archives Journals

An observational study that examined the comparative effectiveness of rhythm control vs. rate control drug treatment on mortality in patients with atrial fibrillation (a rapid, irregular heart beat) suggests there was little difference in mortality within four years of treatment, but rhythm control may be associated with more effective long-term outcomes, according to a report published Online First by Archives of Internal Medicine.

AF affects approximately 2.3 million Americans and 250,000 Canadians, and the condition has a complex therapy that may involve rate control agents, antiarrhythmic drugs, anticoagulant drugs and/or ablative techniques (use of a to eliminate the anatomic source of the ), according to study background.

"Controversy continues concerning the choice of rhythm control vs. rate control for atrial fibrillation (AF). A recent clinical trial showed no difference in five-year mortality between the two treatments. We aimed to determine whether the two strategies have similar effectiveness when applied to a general population of patients with AF with longer follow-up," the authors write as background.

Raluca Ionescu-Ittu, Ph.D., of the Harvard School of Public Health, Boston, and colleagues used population-based databases from Quebec, Canada, from 1999 to 2007 to select patients 66 years or older hospitalized with AF who did not have AF-related drug prescriptions in the year before they were hospitalized but received one within seven days of discharge.

"We found that with increasing follow-up time the mortality among the patients who newly initiated rhythm control therapy gradually decreased relative to those who initiated rate control drugs, reaching 23 percent reduction after eight years of follow-up," the authors comment.

The researchers note that recent clinical trials comparing the two treatments "concluded that there are no differences in mortality between the two treatment strategies."

"For the first four years after treatment initiation, our results in a population-based sample are similar to the results from the recent . In addition, we found a tendency toward a long-term protective effect for rhythm control drugs. The long-term benefits of rhythm control drugs in AF found in this study need to be assessed in future studies," the researchers conclude.

In an editorial, Thomas A. Dewland, M.D., and Gregory M. Marcus, M.D., M.A.S., of the University of California, San Francisco, write: "How do we best interpret this unexpected result given contrary evidence from prior randomized trials?"

"Although the findings of Ionescu-Ittu et al are provocative, they are insufficient to recommend a universal rhythm control strategy for all patients with AF. Randomization is a powerful tool that unfortunately cannot be reliably reproduced with statistical modeling," the authors conclude.

Explore further: Atrial fibrillation: New management approaches for the 'new epidemic' in cardiovascular disease

More information: Arch Intern Med. Published online June 4, 2012. doi:10.1001/archinternmed.2012.2266
Arch Intern Med. Published online June 4, 2012. doi:10.1001/archinternmed.2012.2332


Related Stories

Atrial fibrillation: New management approaches for the 'new epidemic' in cardiovascular disease

June 26, 2011
Despite recent advances in the treatment of heart rhythm disturbances, mortality and morbidity rates associated withy atrial fibrillation (AF) remain "unacceptably high", according to a new report. The report, prepared jointly ...

The Medical Minute: Atrial Fibrillation -- What is It?

October 6, 2011
Atrial fibrillation (AF) is the most common heart rhythm disturbance in the United States and affects 2 to 4 million Americans. It is usually a disease of aging, however it can affect people of all ages -- 1 percent of people ...

The big risk factor for stroke that you may not know you have

September 15, 2011
A cardiac condition called atrial fibrillation, the most common cardiac arrhythmia, can increase your risk of stroke by 500 percent. That's why Anne B. Curtis, MD, Charles and Mary Bauer Professor and Chair of the University ...

Risk of stroke greater for women than men among older patients diagnosed with atrial fibrillation

May 8, 2012
In a study that examined use of the anticoagulant medication warfarin and risk of stroke following a diagnosis of atrial fibrillation in older patients, women, especially those 75 years or older, had a higher risk of stroke ...

Recommended for you

A nanoparticle inhalant for treating heart disease

January 18, 2018
A team of researchers from Italy and Germany has developed a nanoparticle inhalant for treating people suffering from heart disease. In their paper published in the journal Science Translational Medicine, the group describes ...

Starting periods before age of 12 linked to heightened risk of heart disease and stroke

January 15, 2018
Starting periods early—before the age of 12—is linked to a heightened risk of heart disease and stroke in later life, suggests an analysis of data from the UK Biobank study, published online in the journal Heart.

'Decorated' stem cells could offer targeted heart repair

January 10, 2018
Although cardiac stem cell therapy is a promising treatment for heart attack patients, directing the cells to the site of an injury - and getting them to stay there - remains challenging. In a new pilot study using an animal ...

Two simple tests could help to pinpoint cause of stroke

January 10, 2018
Detecting the cause of the deadliest form of stroke could be improved by a simple blood test added alongside a routine brain scan, research suggests.

Exercise is good for the heart, high blood pressure is bad—researchers find out why

January 10, 2018
When the heart is put under stress during exercise, it is considered healthy. Yet stress due to high blood pressure is bad for the heart. Why? And is this always the case? Researchers of the German Centre for Cardiovascular ...

Heart-muscle patches made with human cells improve heart attack recovery

January 10, 2018
Large, human cardiac-muscle patches created in the lab have been tested, for the first time, on large animals in a heart attack model. This clinically relevant approach showed that the patches significantly improved recovery ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.