TY  - JOUR
T1  - COmparative effectiveness of rhythm control vs rate control drug treatment effect on mortality in patients with atrial fibrillation
AU  - Ionescu-Ittu R, Abrahamowicz M, Jackevicius CA, et al
Y1  - 2012/07/09
N1  - 10.1001/archinternmed.2012.2266
JO  - Archives of Internal Medicine
SP  - 997
EP  - 1004
VL  - 172
IS  - 13
N2  - Background 
                  Controversy continues concerning the choice of rhythm control vs rate control treatment strategies for atrial fibrillation (AF). A recent clinical trial showed no difference in 5-year mortality between the 2 treatments. We aimed to determine whether the 2 strategies have similar effectiveness when applied to a general population of patients with AF with longer follow-up.Methods 
                  We used population-based administrative databases from Quebec, Canada, from 1999 to 2007 to select patients 66 years or older hospitalized with an AF diagnosis who did not have AF-related drug prescriptions in the year before the admission but received a prescription within 7 days of discharge. Patients were followed until death or administrative censoring. Mortality was analyzed by multivariable Cox regression.Results 
                  Among 26 130 patients followed for a mean (SD) period of 3.1 years (2.3 years), there were 13 237 deaths (49.5%). After adjusting for covariates, we found that the effect of rhythm vs rate control drugs changed over time: after a small increase in mortality for patients treated with rhythm control in the 6 months following treatment initiation (hazard ratio [HR], 1.07; 95% CI, 1.01-1.14), the mortality was similar between the 2 groups until year 4 but decreased steadily in the rhythm control group after year 5 (HR, 0.89; 95% CI, 0.81-0.96; and HR, 0.77; 95% CI, 0.62-0.95, after 5 and 8 years, respectively).Conclusions 
                  In this population-based sample of patients with AF, we found little difference in mortality within 4 years of treatment initiation between patients with AF initiating rhythm control therapy vs those initiating rate control therapy. However, rhythm control therapy seems to be superior in the long-term.
SN  - 0003-9926
M3  - doi: 10.1001/archinternmed.2012.2266
UR  - http://dx.doi.org/10.1001/archinternmed.2012.2266
ER  -