Arrhythmias & electrophysiology
Outcomes of Early Rhythm Control Therapy in Patients With Atrial Fibrillation and a High Comorbidity Burden in Large Real-World Cohorts
Authors' conclusion
ERC is safe and may be more favorable in a population-based sample of patients with high a comorbidity burden (CHA2DS2-VASc score ≥4).
Study context
- Population
- Patients with newly diagnosed AF and CHA2DS2-VASc score ≥2, US claims database (OptumLabs) and UK Biobank109,739 OptumLabs
- Exposure
- Early rhythm control (ERC) vs no ERC, by comorbidity burden
- Outcome
- Composite of:
- All-cause mortality
- Stroke
- Hospitalization with HF or MI
Methodological detailspropensity score overlap weighting, 2 cohorts (OptumLabs, UKB)
- Propensity score overlap weighting
- 2 cohorts (OptumLabs, UKB)
Main finding
As reported in the abstract
Composite of:
- All-cause mortality
- Stroke
- Hospitalization for HF or MI
ERC vs No ERCHazard ratio (95% CI)P value
High comorbidity burden, OptumLabs
0.83(0.72–0.95)
P = 0.006High comorbidity burden, UKB
0.77(0.63–0.94)
P = 0.009Lower comorbidity burden, OptumLabs; not significant
0.92(0.54–1.57)
P = 0.767Lower comorbidity burden, UKB; not significant
0.94(0.83–1.06)
P = 0.310Observational data: associations, not effects.
Safety
Primary composite safety outcome (death, stroke, serious adverse events related to ERC)
- ERC not associated with increased risk for the primary safety outcome
Original publication
Outcomes of Early Rhythm Control Therapy in Patients With Atrial Fibrillation and a High Comorbidity Burden in Large Real-World Cohorts. Circ Arrhythm Electrophysiol. Published 21 March 2023. doi:10.
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