TY - JOUR
T1 - Rate Control Efficacy in Permanent Atrial Fibrillation
T2 - Successful and Failed Strict Rate Control Against a Background of Lenient Rate Control
AU - Groenveld, Hessel F.
AU - Tijssen, Jan G. P.
AU - Crijns, Harry J. G. M.
AU - Van den Berg, Maarten P.
AU - Hillege, Hans L.
AU - Alings, Marco
AU - Van Veldhuisen, Dirk J.
AU - Van Gelder, Isabelle C.
AU - RACE II Investigators
PY - 2013/2/19
Y1 - 2013/2/19
N2 - Objectives This study sought to investigate differences in outcome between patients treated with successful strict, failed strict, and lenient rate control.Background The RACE II (Rate Control Efficacy in Permanent Atrial Fibrillation) study showed no difference in outcome between lenient and strict rate control in patients with permanent atrial fibrillation (AF). However, in the strict group not all patients achieved the pre-defined heart rate target.Methods The primary outcome was a composite of cardiovascular morbidity and mortality. For the current analysis outcome events were analyzed from end of the dose-adjustment phase until end of follow-up (median 2.9 years [interquartile range: 2.4 to 3.0 years]). Of 614 patients, 608 completed the dose-adjustment phase-301 in the strict (resting heart rateResults Heart rate was different after the dose-adjustment phase between the successful strict (72 +/- 7 beats/min), failed strict (86 +/- 14 beats/min), and lenient (93 +/- 8 beats/min) group (p <0.001) and remained significantly different during follow-up. The primary outcome was reached in 27 of 203 (14.2% KM estimate) in the successful strict versus 14 of 98 (15%) in the failed strict versus 35 of 307 (12.1%) in the lenient group (p = 0.5). The components of the primary outcome and quality of life were similar in the groups.Conclusions In patients with permanent AF, successful strict rate control does not improve outcome. Therefore, lenient rate control might be frontline therapy. (J Am Coll Cardiol 2013;61:741-8) (C) 2013 by the American College of Cardiology Foundation
AB - Objectives This study sought to investigate differences in outcome between patients treated with successful strict, failed strict, and lenient rate control.Background The RACE II (Rate Control Efficacy in Permanent Atrial Fibrillation) study showed no difference in outcome between lenient and strict rate control in patients with permanent atrial fibrillation (AF). However, in the strict group not all patients achieved the pre-defined heart rate target.Methods The primary outcome was a composite of cardiovascular morbidity and mortality. For the current analysis outcome events were analyzed from end of the dose-adjustment phase until end of follow-up (median 2.9 years [interquartile range: 2.4 to 3.0 years]). Of 614 patients, 608 completed the dose-adjustment phase-301 in the strict (resting heart rateResults Heart rate was different after the dose-adjustment phase between the successful strict (72 +/- 7 beats/min), failed strict (86 +/- 14 beats/min), and lenient (93 +/- 8 beats/min) group (p <0.001) and remained significantly different during follow-up. The primary outcome was reached in 27 of 203 (14.2% KM estimate) in the successful strict versus 14 of 98 (15%) in the failed strict versus 35 of 307 (12.1%) in the lenient group (p = 0.5). The components of the primary outcome and quality of life were similar in the groups.Conclusions In patients with permanent AF, successful strict rate control does not improve outcome. Therefore, lenient rate control might be frontline therapy. (J Am Coll Cardiol 2013;61:741-8) (C) 2013 by the American College of Cardiology Foundation
KW - atrial fibrillation
KW - outcome
KW - quality of life
KW - rate control
KW - QUALITY-OF-LIFE
KW - RHYTHM MANAGEMENT AFFIRM
KW - CHRONIC HEART-FAILURE
KW - TASK-FORCE
KW - RACE II
KW - GUIDELINES
KW - INTENSITY
KW - SOCIETY
U2 - 10.1016/j.jacc.2012.11.038
DO - 10.1016/j.jacc.2012.11.038
M3 - Article
SN - 0735-1097
VL - 61
SP - 741
EP - 748
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 7
ER -