Functional Status in Rate- Versus Rhythm-Control Strategies for Atrial Fibrillation
| Autor: | H. Leon Greene, Mina K. Chung, Affirm Investigators, David Sherman, David B. Hogan, Soo G. Kim, D. George Wyse, Joyce C Kellen, Lisa W. Martin, Lynn Shemanski, Yves Rosenberg |
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| Rok vydání: | 2005 |
| Předmět: |
medicine.medical_specialty
Heart disease business.industry Atrial fibrillation Canadian Cardiovascular Society 030204 cardiovascular system & hematology medicine.disease Angina 03 medical and health sciences 0302 clinical medicine Internal medicine Heart rate medicine Cardiology Sinus rhythm 030212 general & internal medicine Risk factor Cardiology and Cardiovascular Medicine business Stroke |
| Zdroj: | Journal of the American College of Cardiology. 46:1891-1899 |
| ISSN: | 0735-1097 |
| Popis: | OBJECTIVES The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) functional status substudy aimed to test the hypothesis that functional status is similar in rate-control and rhythm-control strategies. BACKGROUND Randomized studies, including the AFFIRM study, have failed to demonstrate survival benefits between rate-control and rhythm-control strategies for atrial fibrillation (AF). However, AF may cause functional capacity or cognitive impairment that might justify maintenance of sinus rhythm. METHODS Investigators of the AFFIRM study enrolled 4,060 patients with AF who required long-term therapy and who were 65 years of age or older or who had another risk factor for stroke or death. New York Heart Association functional class (NYHA-FC) and Canadian Cardiovascular Society Angina Classification were assessed at initial and each follow-up visit. From 22 randomly chosen functional status substudy sites, 245 participants underwent 6-min walk tests and Mini-Mental State Examination (MMSE) at initial, two-month, and yearly visits. Patients were assigned randomly to rate-controlling drugs, allowing AF to persist, or rhythm-controlling antiarrhythmic drugs, to maintain sinus rhythm. RESULTS The NYHA-FC worsened with time in both rate-control and rhythm-control groups, with no differences between groups. Presence of AF was associated with worse NYHA-FC (p < 0.0001). No differences were observed in Canadian Cardiovascular Society Angina Classification or MMSE scores. Six-minute walk distance improved over time in both study arms. On average, walk distance was 94 feet greater in the rhythm-control group (adjusted p = 0.049). CONCLUSIONS Modest improvement in 6-min walk distance was noted in the rhythm-control arm. Presence of AF was associated with worse NYHA-FC. No difference in cognitive function was detected. |
| Databáze: | OpenAIRE |
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