TY - JOUR
T1 - Impact of treatment crossovers on clinical outcomes in the rate and rhythm control strategies for atrial fibrillation
T2 - Insights from the AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) trial
AU - Maan, Abhishek
AU - Zhang, Zheng
AU - Qin, Ziling
AU - Wang, Yanbing
AU - Dudley, Samuel
AU - Dabhadakar, Kaustubh
AU - Refaat, Marwan
AU - Mansour, Moussa
AU - Ruskin, Jeremy N.
AU - Heist, E. Kevin
N1 - Publisher Copyright:
© 2017 Wiley Periodicals, Inc.
PY - 2017/7
Y1 - 2017/7
N2 - We investigated the rates and reasons for crossover to alternative treatment strategies and its impact on mortality in patients who were enrolled in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial. Over a mean follow-up period of 3.5 years, 842 patients underwent crossover to the alternative treatment arms in AFFIRM. The rate of crossover from rhythm to rate control (594/2,033, 29.2%) was more frequent than the rate of crossover from rate to rhythm control (248/2,027, 12.2%, P < 0.0001). The leading reasons for crossover from rhythm to rate control were failure to achieve or maintain sinus rhythm (272/594, 45.8%) and intolerable adverse effects (122/594, 20.5%). In comparison, the major reasons for crossover from rate to rhythm control were failure to control atrial fibrillation symptoms (159/248, 64.1%) and intolerable adverse effects (9/248, 3.6%). This difference in crossover pattern was statistically significant (P < 0.0001). There was a significantly decreased risk of all-cause mortality (adjusted HR: 0.61, 95% CI: 0.48–0.78, P < 0.0001) and cardiac mortality (adjusted hazard ratio [HR]: 0.61, 95% confidence interval [CI]: 0.43–0.88, P = 0.008) in the subgroup of patients who crossed over from rhythm to rate control as compared to those who continued in rhythm control. There was a nonsignificant trend toward decreased all-cause (adjusted HR: 0.76, 95% CI: 0.53–1.10, P = 0.14) and cardiac mortality (adjusted HR: 0.70, 95% CI: 0.42–1.18, P = 0.18) in patients who crossed over from rate to rhythm control as compared to those who continued rate control.
AB - We investigated the rates and reasons for crossover to alternative treatment strategies and its impact on mortality in patients who were enrolled in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial. Over a mean follow-up period of 3.5 years, 842 patients underwent crossover to the alternative treatment arms in AFFIRM. The rate of crossover from rhythm to rate control (594/2,033, 29.2%) was more frequent than the rate of crossover from rate to rhythm control (248/2,027, 12.2%, P < 0.0001). The leading reasons for crossover from rhythm to rate control were failure to achieve or maintain sinus rhythm (272/594, 45.8%) and intolerable adverse effects (122/594, 20.5%). In comparison, the major reasons for crossover from rate to rhythm control were failure to control atrial fibrillation symptoms (159/248, 64.1%) and intolerable adverse effects (9/248, 3.6%). This difference in crossover pattern was statistically significant (P < 0.0001). There was a significantly decreased risk of all-cause mortality (adjusted HR: 0.61, 95% CI: 0.48–0.78, P < 0.0001) and cardiac mortality (adjusted hazard ratio [HR]: 0.61, 95% confidence interval [CI]: 0.43–0.88, P = 0.008) in the subgroup of patients who crossed over from rhythm to rate control as compared to those who continued in rhythm control. There was a nonsignificant trend toward decreased all-cause (adjusted HR: 0.76, 95% CI: 0.53–1.10, P = 0.14) and cardiac mortality (adjusted HR: 0.70, 95% CI: 0.42–1.18, P = 0.18) in patients who crossed over from rate to rhythm control as compared to those who continued rate control.
KW - AFFIRM
KW - atrial fibrillation
KW - crossover
KW - rate and rhythm control strategies
UR - http://www.scopus.com/inward/record.url?scp=85021700327&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85021700327&partnerID=8YFLogxK
U2 - 10.1111/pace.13112
DO - 10.1111/pace.13112
M3 - Article
C2 - 28543286
AN - SCOPUS:85021700327
SN - 0147-8389
VL - 40
SP - 770
EP - 778
JO - PACE - Pacing and Clinical Electrophysiology
JF - PACE - Pacing and Clinical Electrophysiology
IS - 7
ER -