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Rhythm vs. rate control of atrial fibrillation meta‐analysed by number needed to treat
Author(s) -
Kumana Cyrus R.,
Cheung Bernard M. Y.,
Cheung Giselle T. Y.,
Ovedal Tori,
Pederson Bjorn,
Lauder Ian J.
Publication year - 2005
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/j.1365-2125.2005.02449.x
Subject(s) - medicine , number needed to treat , atrial fibrillation , randomized controlled trial , relative risk , meta analysis , confidence interval , stroke (engine) , adverse effect , rhythm , intensive care medicine , mechanical engineering , engineering
Background Whenever feasible, rhythm control of atrial fibrillation (AF) was generally preferred over rate control, in the belief that it offered better symptomatic relief and quality of life, and eliminated the need for anticoagulation. However, recent trials appear to challenge these assumptions. Aims To explore the desirability of rhythm vs. rate control of AF by systematic review of pertinent, published, randomized controlled trials (RCTs) and a meta‐analysis by number needed to treat (NNT) year −1 , with respect to diverse clinically important outcomes. Methods RCTs of outcome primarily comparing rate vs. rhythm control in patients with spontaneous AF were identified. For each outcome and assuming rhythm control to be the active treatment, relative risk reduction (RRR) and NNT year −1 were derived for individual trials together with an NNT year −1 for all trials combined; corresponding 95% confidence intervals (CI) were also calculated. Adverse drug reaction (ADR) and quality of life reporting were also assessed. Results In all, data from five suitable RCTs (entailing 5239 patients) were analysed. For hospitalization, available RRRs and NNT year −1 values were all clinically and statistically significant. Overall, one additional patient was hospitalized for every 35 assigned to rhythm control (95% CI 27, 48). For the endpoints of death, ‘ischaemic’ stroke and ‘non‐CNS’ bleeding, there was no significant difference. ADRs were significantly more common in rhythm control patients, whereas quality of life assessments revealed no difference. Thromboembolism was associated with cessation of or subtherapeutic anticoagulation, irrespective of treatment assignment. Conclusion Reduced risk of hospitalization and non‐inferiority for other endpoints all favour rate control, the less costly strategy. If symptoms of AF are not a problem, treatment should target optimizing rate control and more widespread and effective prophylactic anticoagulation.