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Benefits of Rhythm Control and Rate Control in Recent‐onset Atrial Fibrillation: The HERMES ‐ AF Study
Author(s) -
Martín Alfonso,
CollVinent Blanca,
Suero Coral,
FernándezSimón Amparo,
Sánchez Juan,
Varona Mercedes,
Cancio Manuel,
Sánchez Susana,
Carbajosa José,
Malagón Francisco,
Montull Eugeni,
Arco Carmen
Publication year - 2019
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.13703
Subject(s) - medicine , atrial fibrillation , confidence interval , odds ratio , rhythm , observational study , heart rate , heart failure , cardiology , heart rhythm , clinical endpoint , randomized controlled trial , blood pressure
Background Although rhythm control has failed to demonstrate long‐term benefits over rate control in longstanding episodes of atrial fibrillation ( AF ), there is little evidence concerning recent‐onset ones. We analyzed the benefits of rhythm and rate control in terms of symptoms alleviation and need for hospital admission in patients with recent‐onset AF . Methods This was a multicenter, observational, cross‐sectional study with prospective standardized data collection carried out in 124 emergency departments ( ED s). Clinical variables, treatment effectiveness, and outcomes (control of symptoms, final disposition) were analyzed in stable patients with recent‐onset AF consulting for AF ‐related symptoms. Results Of 421 patients included, rhythm control was chosen in 352 patients (83.6%), a global effectiveness of 84%. Rate control was performed in 69 patients (16.4%) and was achieved in 67 (97%) of them. Control of symptoms was achieved in 396 (94.1%) patients and was associated with a heart rate after treatment ≤ 110 beats/min (odds ratio [ OR ] = 14.346, 95% confidence interval [ CI ] = 3.90 to 52.70, p < 0.001) and a rhythm control strategy ( OR = 2.78, 95% CI = 1.02 to 7.61, p = 0.046). Sixty patients (14.2%) were admitted: discharge was associated with a rhythm control strategy (OR = 2.22, 95% CI = 1.20‐4.60, p = 0.031) and admission was associated with a heart rate > 110 beats/min after treatment ( OR = 29.71, 95% CI = 7.19 to 123.07, p < 0.001) and acute heart failure ( OR = 9.45, 95% CI = 2.91 to 30.65, p < 0.001). Conclusion In our study, recent‐onset AF patients in whom rhythm control was attempted in the ED had a high rate of symptoms' alleviation and a reduced rate of hospital admissions.