Arrhythmias & electrophysiology
Diabetes and Obesity and Treatment Effect of Early Rhythm Control vs Usual Care in Patients With Atrial Fibrillation: A Secondary Analysis of the EAST-AFNET 4 Randomized Clinical Trial
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
Methodological detailsprespecified, international, investigator-initiated, parallel-group, open, blinded outcome assessment, 11 European countries, Conducted June 2010 to May 2020; analysis performed in 2024
- Prespecified
- International
- Investigator-initiated
- Parallel-group
- Open, blinded outcome assessment
- 11 European countries
- Conducted June 2010 to May 2020; analysis performed in 2024
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: A Secondary Analysis of the EAST-AFNET 4 Randomized Clinical Trial. JAMA Cardiol. Published 1 September 2025. doi:10.
Summarised from the published abstract; every number is checked against it