Rate versus rhythm control in atrial fibrillation and clinical outcomes: Updated systematic review and meta-analysis of randomized controlled trials
| Autor: | Daniel Caldeira, Cláudio David, Cristina Sampaio |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_specialty Bêtabloquants Agents antiarythmiques Risk Assessment Sudden death law.invention Randomized controlled trial Heart Rate Risk Factors law Internal medicine Fibrillation atriale medicine Humans Adrenergic beta-antagonists Antiarrhythmia agents Aged Randomized Controlled Trials as Topic Antagonistes calciques Calcium-channel blockers Evidence-Based Medicine Digitalis business.industry Cardiac arrhythmia Atrial fibrillation General Medicine Middle Aged medicine.disease Confidence interval Treatment Outcome Relative risk Meta-analysis Practice Guidelines as Topic Digitaliques Cardiology Female Cardiology and Cardiovascular Medicine Risk assessment business Anti-Arrhythmia Agents |
| Zdroj: | Archives of Cardiovascular Diseases. 105:226-238 |
| ISSN: | 1875-2136 |
| DOI: | 10.1016/j.acvd.2011.11.005 |
| Popis: | SummaryAtrial fibrillation is the most frequently occurring sustained cardiac arrhythmia and is associated with a significantly increased risk of thromboembolic events and death. We sought to compare the clinical efficacy of rate and rhythm control strategies in patients with non-postoperative atrial fibrillation. We searched the PubMed database and the Cochrane Central Register of Controlled Trials for randomized controlled trials comparing rate versus rhythm control in patients with atrial fibrillation. Studies were retrieved and we analysed major clinical outcomes. Risk ratios (RRs) and 95% confidence intervals were calculated assuming random effects due to the clinical heterogeneity of the study populations. Eight randomized controlled trials were identified, with a total of 7499 patients with atrial fibrillation. There were no significant differences in the effects of rate and rhythm control on any outcome: all-cause mortality (RR: 0.95; CI: 0.86–1.05), cardiovascular mortality (RR: 0.99; CI: 0.87–1.13), arrhythmic/sudden death (RR: 1.12; CI: 0.91–1.38), ischaemic stroke (RR: 0.89; CI: 0.52–1.53), systemic embolism (RR: 0.89; CI: 0.69–1.14) and major bleeding (RR: 1.10; CI: 0.89–1.36). Updated data pooled from a large population of patients with atrial fibrillation suggests that rate and rhythm control strategies have similar effects on major clinical outcomes. Other factors, including individual preferences, comorbidities, drug tolerance and cost issues, should be considered when choosing the approach for these patients. |
| Databáze: | OpenAIRE |
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