Outcomes of Rate-Control Treatment in Patients With Atrial Fibrillation and Heart Failure　― A Nationwide Cohort Study ―

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  • Yu Hee Tae
    Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
  • Yang Pil-Sung
    Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
  • Lee Hancheol
    Division of Cardiology, National Health Insurance Service Ilsan Hospital
  • You Seng Chan
    Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
  • Kim Tae-Hoon
    Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
  • Uhm Jae-Sun
    Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
  • Kim Jong-Youn
    Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
  • Pak Hui-Nam
    Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
  • Lee Moon-Hyoung
    Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
  • Joung Boyoung
    Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine

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<p>Background:Rate control is now a front-line therapy in the management of atrial fibrillation (AF). However, the survival benefits of different rate-control medications remain controversial, so we assessed the efficacy of rate-control medications in AF patients with concomitant heart failure (HF).</p><p>Methods and Results:From January 2002 to December 2008, a total of 7,034 AF patients with a single type of rate-control drug or without rate-control treatment were enrolled from the Korea National Health Insurance Service database. The death rates over a mean follow-up of 4.5±1.2 years were 12.6% (580 of 4,593) and 29.0% (709 of 2,441) in non-HF and HF patients, respectively. Among the total subjects, the risk of death was lower in patients receiving β-blockers (adjusted hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.64–0.88) and calcium-channel blockers (adjusted HR 0.74, 95% CI 0.55–0.98) compared with those who did not receive rate-control medications. In patients without HF, use of rate-control medications did not affect the risk of death. In patients with HF, β-blockers significantly decreased the mortality risk (adjusted HR 0.63, 95% CI 0.50–0.79), whereas use of calcium-channel blockers or digoxin was not associated with death. The results were observed consistently among the cohorts after propensity matching.</p><p>Conclusions:Use of β-blockers was associated with a reduced mortality rate for AF patient with HF but not for those without HF. These findings should be examined in a large randomized trial.</p>

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  • Circulation Journal

    Circulation Journal 82 (3), 652-658, 2018

    一般社団法人 日本循環器学会

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