Clinical Impact of Early Rhythm Control and Healthy Lifestyles in Patients With Atrial Fibrillation

So-Ryoung Lee; Eue-Keun Choi; Seung-Woo Lee; Kyung-Do Han; Seil Oh; Gregory Y H Lip

doi:10.1016/j.jacep.2024.02.016

Clinical Impact of Early Rhythm Control and Healthy Lifestyles in Patients With Atrial Fibrillation

JACC Clin Electrophysiol. 2024 Apr 4:S2405-500X(24)00159-2. doi: 10.1016/j.jacep.2024.02.016. Online ahead of print.

Authors

So-Ryoung Lee¹, Eue-Keun Choi², Seung-Woo Lee³, Kyung-Do Han⁴, Seil Oh¹, Gregory Y H Lip⁵

Affiliations

¹ Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
² Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: choiek17@snu.ac.kr.
³ Department of Medical Statistics, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea.
⁴ Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea.
⁵ Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Chest and Heart Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

PMID: 38661604
DOI: 10.1016/j.jacep.2024.02.016

Abstract

Background: There are limited data regarding the combined effect of early rhythm control (ERC) and healthy lifestyle (HLS) behaviors on the risk of ischemic stroke in patients with atrial fibrillation (AF).

Objectives: This study sought to evaluate how the combination of ERC and HLS behaviors affects the risk of ischemic stroke in patients with AF.

Methods: Using the Korean National Health Insurance database, we included patients with new-onset AF between 2009 and 2016 (n = 208,662). Patients who received rhythm control therapy within 2 years after AF diagnosis were defined as the ERC group. Patients with ≥2 HLS behaviors were defined as the HLS group. Patients were categorized into 4 groups: group 1, without ERC and without HLS (n = 46,972); group 2, with HLS alone (n = 110,479); group 3, with ERC alone (n = 15,133); and group 4, with both ERC and HLS (n = 36,078). The primary outcome was ischemic stroke.

Results: Compared to group 1, group 2 and group 3 were associated with a lower risk of stroke (HR: 0.769 [95% CI: 0.728-0.881] and HR: 0.774 [95% CI: 0.703-0.852], respectively). Group 4 showed the lowest risk of stroke (HR: 0.575; 95% CI: 0.536-0.617). After propensity score weighting, the incorporation of additional ERC alongside HLS was associated with a relative risk reduction of 22% for stroke, and additional HLS alongside ERC were associated with a relative risk reduction of 27% for stroke.

Conclusions: Each of ERC and HLS might reduce the risk of ischemic stroke in patients with new-onset AF. The presence of both ERC and HLS is associated with an enhanced benefit for stroke prevention in this population.

Keywords: atrial fibrillation; lifestyle modification; rhythm control; stroke.