Comparison of rhythm and rate control strategies for stroke occurrence in a prospective cohort of atrial fibrillation patients

Yu Jeong Choi, Ki Woon Kang, Tae Hoon Kim, Myung Jin Cha, Jung Myung Lee, Junbeom Park, Jin Kyu Park, Jaemin Shim, Jae Sun Uhm, Jun Kim, Hyung Wook Park, Eue Keun Choi, Jin Bae Kim, Changsoo Kim, Young Soo Lee, Boyoung Joung

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose: Comparisons of rhythm and rate control strategies for stroke prevention in patients with atrial fibrillation (AF) are still inconclusive. We compared differences in clinical outcomes between the rhythm and rate control strategies. Materials and Methods: The COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) registry prospectively enrolled 6000 patients who were treated for AF using real-world guideline adherence at multiple referral centers. In total, 2508 (41.8%) patients were clinically followed up for over six months. Of these, 1134 (45.2 %) patients treated by rhythm control and 1374 (54.8 %) patients treated by rate control were analyzed for clinical outcomes, including stroke and cardiovascular outcomes. Results: Among all patients (age, 68±10 years; male, 62.4%), those treated with the rhythm control strategy were significantly younger, had more symptomatic paroxysmal AF, and a shorter AF duration, and were less likely to have diabetes, renal dysfunction, and heart failure, compared to those treated with the rate control strategy (CHA2DS2-VASc score 2.4±1.5 vs. 3.1±1.7, p<0.001). Even though oral anticoagulation was similarly prescribed in both groups, occurrence of stroke was less likely to occur in the rhythm control strategy group (0.0% vs. 0.7%, p=0.015). Multivariate Cox hazard regression showed that only age, especially more than 75 years old, were significantly correlated with the occurrence of stroke, regardless of the strategy used for treatment. Conclusion: In this prospective AF cohort, compared with the rate control strategy, the rhythm control strategy was associated with fewer cardiovascular events and strokes in a short-term period.

Original languageEnglish
Pages (from-to)258-264
Number of pages7
JournalYonsei medical journal
Volume59
Issue number2
DOIs
Publication statusPublished - 2018 Mar

Fingerprint

Atrial Fibrillation
Stroke
Myocardial Infarction
Guideline Adherence
Drug and Narcotic Control
Renal Insufficiency
Registries
Referral and Consultation
Heart Failure
Control Groups

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Choi, Yu Jeong ; Kang, Ki Woon ; Kim, Tae Hoon ; Cha, Myung Jin ; Lee, Jung Myung ; Park, Junbeom ; Park, Jin Kyu ; Shim, Jaemin ; Uhm, Jae Sun ; Kim, Jun ; Park, Hyung Wook ; Choi, Eue Keun ; Kim, Jin Bae ; Kim, Changsoo ; Lee, Young Soo ; Joung, Boyoung. / Comparison of rhythm and rate control strategies for stroke occurrence in a prospective cohort of atrial fibrillation patients. In: Yonsei medical journal. 2018 ; Vol. 59, No. 2. pp. 258-264.
@article{c71b420de64944f98356212e8af19eba,
title = "Comparison of rhythm and rate control strategies for stroke occurrence in a prospective cohort of atrial fibrillation patients",
abstract = "Purpose: Comparisons of rhythm and rate control strategies for stroke prevention in patients with atrial fibrillation (AF) are still inconclusive. We compared differences in clinical outcomes between the rhythm and rate control strategies. Materials and Methods: The COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) registry prospectively enrolled 6000 patients who were treated for AF using real-world guideline adherence at multiple referral centers. In total, 2508 (41.8{\%}) patients were clinically followed up for over six months. Of these, 1134 (45.2 {\%}) patients treated by rhythm control and 1374 (54.8 {\%}) patients treated by rate control were analyzed for clinical outcomes, including stroke and cardiovascular outcomes. Results: Among all patients (age, 68±10 years; male, 62.4{\%}), those treated with the rhythm control strategy were significantly younger, had more symptomatic paroxysmal AF, and a shorter AF duration, and were less likely to have diabetes, renal dysfunction, and heart failure, compared to those treated with the rate control strategy (CHA2DS2-VASc score 2.4±1.5 vs. 3.1±1.7, p<0.001). Even though oral anticoagulation was similarly prescribed in both groups, occurrence of stroke was less likely to occur in the rhythm control strategy group (0.0{\%} vs. 0.7{\%}, p=0.015). Multivariate Cox hazard regression showed that only age, especially more than 75 years old, were significantly correlated with the occurrence of stroke, regardless of the strategy used for treatment. Conclusion: In this prospective AF cohort, compared with the rate control strategy, the rhythm control strategy was associated with fewer cardiovascular events and strokes in a short-term period.",
author = "Choi, {Yu Jeong} and Kang, {Ki Woon} and Kim, {Tae Hoon} and Cha, {Myung Jin} and Lee, {Jung Myung} and Junbeom Park and Park, {Jin Kyu} and Jaemin Shim and Uhm, {Jae Sun} and Jun Kim and Park, {Hyung Wook} and Choi, {Eue Keun} and Kim, {Jin Bae} and Changsoo Kim and Lee, {Young Soo} and Boyoung Joung",
year = "2018",
month = "3",
doi = "10.3349/ymj.2018.59.2.258",
language = "English",
volume = "59",
pages = "258--264",
journal = "Yonsei Medical Journal",
issn = "0513-5796",
publisher = "Yonsei University College of Medicine",
number = "2",

}

Choi, YJ, Kang, KW, Kim, TH, Cha, MJ, Lee, JM, Park, J, Park, JK, Shim, J, Uhm, JS, Kim, J, Park, HW, Choi, EK, Kim, JB, Kim, C, Lee, YS & Joung, B 2018, 'Comparison of rhythm and rate control strategies for stroke occurrence in a prospective cohort of atrial fibrillation patients', Yonsei medical journal, vol. 59, no. 2, pp. 258-264. https://doi.org/10.3349/ymj.2018.59.2.258

Comparison of rhythm and rate control strategies for stroke occurrence in a prospective cohort of atrial fibrillation patients. / Choi, Yu Jeong; Kang, Ki Woon; Kim, Tae Hoon; Cha, Myung Jin; Lee, Jung Myung; Park, Junbeom; Park, Jin Kyu; Shim, Jaemin; Uhm, Jae Sun; Kim, Jun; Park, Hyung Wook; Choi, Eue Keun; Kim, Jin Bae; Kim, Changsoo; Lee, Young Soo; Joung, Boyoung.

In: Yonsei medical journal, Vol. 59, No. 2, 03.2018, p. 258-264.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparison of rhythm and rate control strategies for stroke occurrence in a prospective cohort of atrial fibrillation patients

AU - Choi, Yu Jeong

AU - Kang, Ki Woon

AU - Kim, Tae Hoon

AU - Cha, Myung Jin

AU - Lee, Jung Myung

AU - Park, Junbeom

AU - Park, Jin Kyu

AU - Shim, Jaemin

AU - Uhm, Jae Sun

AU - Kim, Jun

AU - Park, Hyung Wook

AU - Choi, Eue Keun

AU - Kim, Jin Bae

AU - Kim, Changsoo

AU - Lee, Young Soo

AU - Joung, Boyoung

PY - 2018/3

Y1 - 2018/3

N2 - Purpose: Comparisons of rhythm and rate control strategies for stroke prevention in patients with atrial fibrillation (AF) are still inconclusive. We compared differences in clinical outcomes between the rhythm and rate control strategies. Materials and Methods: The COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) registry prospectively enrolled 6000 patients who were treated for AF using real-world guideline adherence at multiple referral centers. In total, 2508 (41.8%) patients were clinically followed up for over six months. Of these, 1134 (45.2 %) patients treated by rhythm control and 1374 (54.8 %) patients treated by rate control were analyzed for clinical outcomes, including stroke and cardiovascular outcomes. Results: Among all patients (age, 68±10 years; male, 62.4%), those treated with the rhythm control strategy were significantly younger, had more symptomatic paroxysmal AF, and a shorter AF duration, and were less likely to have diabetes, renal dysfunction, and heart failure, compared to those treated with the rate control strategy (CHA2DS2-VASc score 2.4±1.5 vs. 3.1±1.7, p<0.001). Even though oral anticoagulation was similarly prescribed in both groups, occurrence of stroke was less likely to occur in the rhythm control strategy group (0.0% vs. 0.7%, p=0.015). Multivariate Cox hazard regression showed that only age, especially more than 75 years old, were significantly correlated with the occurrence of stroke, regardless of the strategy used for treatment. Conclusion: In this prospective AF cohort, compared with the rate control strategy, the rhythm control strategy was associated with fewer cardiovascular events and strokes in a short-term period.

AB - Purpose: Comparisons of rhythm and rate control strategies for stroke prevention in patients with atrial fibrillation (AF) are still inconclusive. We compared differences in clinical outcomes between the rhythm and rate control strategies. Materials and Methods: The COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) registry prospectively enrolled 6000 patients who were treated for AF using real-world guideline adherence at multiple referral centers. In total, 2508 (41.8%) patients were clinically followed up for over six months. Of these, 1134 (45.2 %) patients treated by rhythm control and 1374 (54.8 %) patients treated by rate control were analyzed for clinical outcomes, including stroke and cardiovascular outcomes. Results: Among all patients (age, 68±10 years; male, 62.4%), those treated with the rhythm control strategy were significantly younger, had more symptomatic paroxysmal AF, and a shorter AF duration, and were less likely to have diabetes, renal dysfunction, and heart failure, compared to those treated with the rate control strategy (CHA2DS2-VASc score 2.4±1.5 vs. 3.1±1.7, p<0.001). Even though oral anticoagulation was similarly prescribed in both groups, occurrence of stroke was less likely to occur in the rhythm control strategy group (0.0% vs. 0.7%, p=0.015). Multivariate Cox hazard regression showed that only age, especially more than 75 years old, were significantly correlated with the occurrence of stroke, regardless of the strategy used for treatment. Conclusion: In this prospective AF cohort, compared with the rate control strategy, the rhythm control strategy was associated with fewer cardiovascular events and strokes in a short-term period.

UR - http://www.scopus.com/inward/record.url?scp=85042138212&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85042138212&partnerID=8YFLogxK

U2 - 10.3349/ymj.2018.59.2.258

DO - 10.3349/ymj.2018.59.2.258

M3 - Article

C2 - 29436194

AN - SCOPUS:85042138212

VL - 59

SP - 258

EP - 264

JO - Yonsei Medical Journal

JF - Yonsei Medical Journal

SN - 0513-5796

IS - 2

ER -