Early rhythm control strategy in early atrial fibrillation patients, a retrospective cohort study.

Abstract

Introduction: Atrial fibrillation (AF) treatment strategy on whether to use rhythm control or usual care (UC) has been debated for decades. In early studies, these two strategies showed equivalent efficacy, but more recent studies based on CHA2DS2-VASc score indicated that early rhythm control (ERC) would benefit more than UC strategy. We hypothesized that ERC might benefit AF patients in other cardiovascular outcomes, regardless of CHA2DS2-VASc score. To clarify this, we conducted the current study. Methods: A retrospective cohort study was carried out using the Yinzhou Regional Health Care Database (YRHCD). We included all patients diagnosed with AF within 1 year, while excluding those without age/sex information, no ERC/UC treatment prescription, or with ongoing cancer. The primary outcome was major cardiovascular events (MACE). We used inverse probability of treatment weighting (IPTW) for covariates weighting. Results: In total, 7,161 patients diagnosed with early AF were included in this study, 2,248 and 4,913 were in ERC group and usual care group, respectively. During mean follow-up period 3.2 years (27,945 person-year), and after IPTW, the result remained similar for ERC showed significantly lower risk for MACE (HR: 0.75[0.61, 0.96], P=0.02), and heart failure (HR: 0.71[0.54,0.95], P=0.01). No significant results were found in stroke, cardiovascular death, or all-cause mortality. Conclusion: Early rhythm control is more beneficial to early AF patients than usual care for major cardiovascular events.