TY - JOUR
T1 - Rate versus rhythm control for management of atrial fibrillation in clinical practice
T2 - Results from the outcomes registry for better informed treatment of atrial fibrillation (ORBIT-AF) registry
AU - Steinberg, Benjamin A.
AU - Holmes, Dajuanicia N.
AU - Ezekowitz, Michael D.
AU - Fonarow, Gregg C.
AU - Kowey, Peter R.
AU - Mahaffey, Kenneth W.
AU - Naccarelli, Gerald
AU - Reiffel, James
AU - Chang, Paul
AU - Peterson, Eric D.
AU - Piccini, Jonathan P.
N1 - Funding Information:
The following relationships exist related to this presentation: BS, DNH, and GCF report no relationships; PRK reports consultancy for Boerhinger-Ingelheim, Johnson and Johnson, Bristol Myers Squibb, Pfizer, and Daiich Sankyo. MDE reports speakers bureau with Boehringer Ingelheim and consultancy with Boehringer Ingelheim, ARYx Therapeutics, Pfizer, Sanofi, Bristol-Myers-Squibb, Portola, Diachi-Sanko, Medtronic, Merck, Gilead, and Janssen. KWM reports research support from AstraZeneca, Amgen, Bayer, Boehringer-Ingleheim, Bristol-Myers-Squibb, Daiichi Sankyo, Eli Lilly, GlaxoSmithKline, Johnson & Johnson, Merck, Novartis, Portola, POZEN Pharmaceutical, Schering-Plough, and The Medicines Company, and consulting agreements with Amgen, AstraZeneca, Glaxo SmithKline, Johnson & Johnson, and Merck; JR reports consultancy and speakers bureau for Janssen; GN reports research grants from Wyeth, Reliant, Medtronic, Boston Scientific, Sanofi-Aventis, and Boehringer Ingelheim, and consultancies to Wyeth, Reliant, Medtronic, Boston Scientific, Sanofi-Aventis, Boehringer Ingelheim, Xention, Pfizer, Novartis, GlaxoSmithKline, and St. Jude Medical; JAR reports research support from Boehringer Ingelheim and GlaxoSmithKline, consultancies with Sanofi-Aventis, Gilead, CV Therapeutics, GlaxoSmithKline, Merck, Cardiome Pharma, Boehringer Ingelheim, Medtronic, and speakers’ bureau with Sanofi-Aventis, Boehringer Ingelheim; PC is an employee of Janssen; EDP reports research support from Eli Lilly & Company and Janssen, JPP reports research support from Boston Scientific Corporation and Janssen and consultancies to Forest Laboratories, Janssen, and Medtronic.
PY - 2013/4
Y1 - 2013/4
N2 - Background All patients with atrial fibrillation (AF) require optimization of their ventricular rate. Factors leading to use of additional rhythm control in clinical practice have not been thoroughly defined. Methods The ORBIT-AF registry enrolled patients with AF from a broad range of practice settings and collected data on rate versus rhythm control, as indicated by the treating physician. Multivariable logistic regression analysis was performed to identify factors associated with each strategy. Results Of 10,061 patients enrolled, 6,859 (68%) were managed with rate only control versus 3,202 (32%) with rhythm control. Patients managed with rate control were significantly older and more likely to have hypertension, heart failure, prior stroke, and gastrointestinal bleeds. They also had fewer AF-related symptoms (41% with no symptoms vs 31% for rhythm control). Systemic anticoagulation was prescribed for 5,448 (79%) rate-control patients versus 2,219 (69%) rhythm-control patients (P <.0001). After multivariable adjustment, patients with higher symptom scores (severe symptoms vs. none, OR 1.62, 95% CI 1.41-1.87) and those referred to electrophysiologists (OR 1.64, 95% CI 1.45-1.85) were more likely to be managed with a rhythm control strategy. Conclusions In this outpatient registry of US clinical practice, the majority of patients with AF were managed with rate control alone. Patients with more symptoms and who were treated by an electrophysiologist were more likely to receive rhythm-control therapies. A significant proportion of AF patients, regardless of treatment strategy, were not treated with anticoagulation for thromboembolism prophylaxis.
AB - Background All patients with atrial fibrillation (AF) require optimization of their ventricular rate. Factors leading to use of additional rhythm control in clinical practice have not been thoroughly defined. Methods The ORBIT-AF registry enrolled patients with AF from a broad range of practice settings and collected data on rate versus rhythm control, as indicated by the treating physician. Multivariable logistic regression analysis was performed to identify factors associated with each strategy. Results Of 10,061 patients enrolled, 6,859 (68%) were managed with rate only control versus 3,202 (32%) with rhythm control. Patients managed with rate control were significantly older and more likely to have hypertension, heart failure, prior stroke, and gastrointestinal bleeds. They also had fewer AF-related symptoms (41% with no symptoms vs 31% for rhythm control). Systemic anticoagulation was prescribed for 5,448 (79%) rate-control patients versus 2,219 (69%) rhythm-control patients (P <.0001). After multivariable adjustment, patients with higher symptom scores (severe symptoms vs. none, OR 1.62, 95% CI 1.41-1.87) and those referred to electrophysiologists (OR 1.64, 95% CI 1.45-1.85) were more likely to be managed with a rhythm control strategy. Conclusions In this outpatient registry of US clinical practice, the majority of patients with AF were managed with rate control alone. Patients with more symptoms and who were treated by an electrophysiologist were more likely to receive rhythm-control therapies. A significant proportion of AF patients, regardless of treatment strategy, were not treated with anticoagulation for thromboembolism prophylaxis.
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U2 - 10.1016/j.ahj.2012.12.019
DO - 10.1016/j.ahj.2012.12.019
M3 - Article
C2 - 23537981
AN - SCOPUS:84875433039
VL - 165
SP - 622
EP - 629
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
IS - 4
ER -