Arrhythmias & electrophysiologySecondary analysis
Diabetes and Obesity and Treatment Effect of Early Rhythm Control vs Usual Care in Patients With Atrial Fibrillation
- Secondary analysis of the EAST-AFNET 4 randomised trial
- prespecified
- international
- investigator-initiated
- parallel-group
- open, blinded outcome assessment
- 11 European countries
- Conducted June 2010 to May 2020; analysis performed in 2024
Authors' conclusion
This secondary analysis of the EAST-AFNET 4 randomized clinical trial shows that early rhythm control therapy retains its effectiveness and safety in patients with and without diabetes and patients with and without obesity.
Study context
- Population
- Patients with early atrial fibrillation (AF) (diagnosed ≤1 year before enrollment) and CV conditions1,086 with, 1690 without obesity
- Comparison
- Early rhythm control vs usual care, by obesity and diabetes
- Primary endpoint
- Composite of:
- CV death
- Stroke
- Hospitalization for HF
- ACS
Primary result
As reported in the abstract
Primary outcome by obesity and diabetes (subgroups)
Early rhythm control vs Usual careHazard ratio (95% CI)
diabetes
0.77(0.57–1.05)
no diabetes
0.78(0.64–0.96)
Hazard rate
- Body mass index (BMI) <30
- 0.84
- BMI ≥30
- 0.69
Safety
Safety outcomes, with vs without diabetes
- Safety outcomes, with vs without diabetes: 64 of 351 vs 167 of 1039
- Safety outcomes, with vs without diabetes: P for interaction = .99
Original publication
Diabetes and Obesity and Treatment Effect of Early Rhythm Control vs Usual Care in Patients With Atrial Fibrillation. JAMA Cardiol. Published 1 September 2025. doi:10.1001/jamacardio.2025.2374
Summarised from the published abstract; every number is checked against it