Rhythm versus rate control in patients with newly diagnosed atrial fibrillation - Observations from the GARFIELD-AF registry

Marita Knudsen Pope; Trygve S Hall; Saverio Virdone; Dan Atar; A John Camm; Karen S Pieper; Petr Jansky; Sylvia Haas; Shinya Goto; Elizaveta Panchenko; Gonzalo Baron-Esquivias; Pantep Angchaisuksiri; Ajay K Kakkar; GARFIELD-AF Investigators

doi:10.1016/j.ijcha.2023.101302

Rhythm versus rate control in patients with newly diagnosed atrial fibrillation - Observations from the GARFIELD-AF registry

Int J Cardiol Heart Vasc. 2023 Nov 16:49:101302. doi: 10.1016/j.ijcha.2023.101302. eCollection 2023 Dec.

Authors

Affiliations

¹ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
² Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway.
³ Thrombosis Research Institute, London, the United Kingdom of Great Britain and Northern Ireland.
⁴ Cardiology Clinical Academic Group Molecular & Clinical Sciences Research Institute, St. George's University of London, London, the United Kingdom of Great Britain and Northern Ireland.
⁵ Department of Cardiovascular Surgery, Motol University Hospital, Prague, Czech Republic.
⁶ Sylvia Haas: Formerly Department of Medicine, Technical University of Munich, Munich, Germany.
⁷ Tokai University, Kanagawa, Japan.
⁸ National Medical Research Center of Cardiology of Ministry of Health of the Russian Federation, Moscow, Russian Federation.
⁹ Servicio de Cardiología y Cirugía Cardíaca, Hospital Universitario Virgen del Rocío., Universidad de Sevilla., Sevilla. Departamento Cardiovascular, Instituto de Biotecnología de Sevilla (IBIS), Spain.
¹⁰ Department of Medicine, Ramathibodi Hospital, Mahidol University, Thailand.

Abstract

Background: Investigate real-world outcomes of early rhythm versus rate control in patients with recent onset atrial fibrillation.

Methods: The Global Anticoagulant Registry in the FIELD-AF (GARFIELD-AF) is an international multi-centre, non-interventional prospective registry of newly diagnosed (≤6 weeks' duration) atrial fibrillation patients at risk for stroke. Patients were stratified according to treatment initiated at baseline (≤48 days post enrolment), and outcome risks evaluated by overlap propensity weighted Cox proportional-hazards models.

Results: Of 45,382 non-permanent atrial fibrillation patients, 23,858 (52.6 %) received rhythm control and 21,524 (47.4 %) rate control. Rhythm-controlled patients had lower median age (68.0 [Q1;Q3: 60.0;76.0] versus 73.0 [65.0;79.0]), fewer histories of stroke/transient ischemic attack/systemic embolism (9.4 % versus 13.0 %), and lower expected probabilities of death (median GARFIELD-AF death score 4.0 [2.3;7.5] versus 5.1 [2.8;9.2]). The two groups had the same median CHA₂DS₂-VASc scores (3.0 [2.0;4.0]) and similar proportions of anticoagulated patients (rhythm control: 66.0 %, rate control: 65.5 %). The propensity-score-weighted hazard ratios of rhythm vs rate control (reference) were 0.85 (95 % CI: 0.79-0.92, p-value < 0.0001) for all-cause mortality, 0.84 (0.72-0.97, p-value 0.020) for non-haemorrhagic stroke/systemic embolism and 0.90 (0.78-1.04, p-value 0.164) for major bleeding.

Conclusion: Rhythm control strategy was initiated in about half of the patients with newly diagnosed non-valvular non-permanent atrial fibrillation. After balancing confounders, significantly lower risks of all-cause mortality and non-haemorrhagic stroke were observed in patients who received early rhythm control.

Keywords: Atrial fibrillation; Mortality; Rate control; Real-world evidence; Rhythm control; Stroke.