Which is Better, Rate Control or Rhythm Control For Atrial Fibrillation: Results From the RECORD AF Registry
Does Permanent Atrial Fibrillation Happen Faster With Rate Drugs or Rhythm Drugs?
November 20, 2009 5:18 AM CT
Reporting at the American Heart Association 2009 Scientific Sessions in Orlando, Prof. John Camm (St. George's Hospital, London, UK) presented the results of the RECORD AF registry (Registry on Cardiac Rhythm Disorders AF). This registry was created in the wake of the AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) trial, which had shown that there was no advantage of rhythm control over rate control in preventing cardiovascular events in atrial fibrillation patients.
AFFIRM was based on randomized trials, whereas the RECORD AF registry was created to determine how afib was being managed in the real world. Representing 21 countries in North and South America, Europe and Asia, it followed 5,604 recently diagnosed atrial fibrillation patients for a year.
For real-world atrial fibrillation treatment, cardiologists chose to use rhythm control 55% of the time and rate control 45%. In general, those who were treated with rhythm medications tended to be younger, whereas those treated with rate medications tended to have a history of heart failure, diabetes, valvular heart disease, or impaired left ventricular ejection fraction.
At the end of a year, more than 80% of the rhythm control patients were in sinus rhythm compared to just one-third of those on rate control. There were no significant differences in outcomes in rate vs. rhythm — instead cardiovascular events depended on co-existing conditions, called co-morbidities, such as diabetes, heart failure, or valvular heart disease.
When it came to hospitalizations, there were differences—those on rhythm control were more likely to be hospitalized for arrhythmias, and those on rate control for heart failure.
Most concerning to afib patients should be that 54% of rate-control patients had progressed in that year to permanent atrial fibrillation whereas only 13% of rhythm-control patients had.
In follow up to RECORD AF, the sponsor has announced a new registry, the RealiseAF Registry (Real Life global Survey Evaluating patients with Atrial Fibrillation). It will provide a real-life picture of the global burden of atrial fibrillation in more than 10,000 patients in 926 centers from 27 countries in Europe, Latin America, Asia, Middle East and North Africa. It will capture details of family and personal cardiovascular risks and history along with the management of afib and the quality of life impact of it.
Comments: These are very significant findings for those with afib, especially since so many recently-diagnosed rate-control patients progressed within just a year to permanent atrial fibrillation. We are also very concerned that those on rate control are at risk for heart failure from overworking the heart, and the hospitalizations in this registry appear to confirm that. These findings will spark a lot of conversations between afib patients and their doctors.
To learn more, see:
- RECORD AF: Better success with rhythm control, but no difference in outcomes, TheHeart.org
- Sanofi-aventis Launches Major New Registry Including Over 10,000 patients Worldwide with Atrial Fibrillation: The RealiseAF registry, Sanofi-aventis.com
- Rate control medication
- Rhythm control medication
Disclaimer: The RECORD AF Registry and the RealiseAF registry are funded by Sanofi-aventis, the maker of Multaq. Sanofi-aventis is one of our many StopAfib.org sponsors. Our policy is to be balanced in our coverage and to avoid favoring sponsors, and thus sponsors must do something especially noteworthy to be covered. These registries and results are particularly noteworthy for the afib community.