Impact of Rate Versus Rhythm Control in Patients With New-Onset Atrial Fibrillation on 30-Day Outcomes

Abstract

Background:

Atrial fibrillation (AF) is associated with an increased risk of stroke and heart failure (HF). Historically, rate control has been the preferred treatment strategy due to fewer adverse drug events, but emerging evidence suggests early rhythm control may offer mortality benefits. Despite this, a critical gap exists in understanding short-term outcomes of rhythm control.

Objectives:

Assess the impact of early rhythm control strategy in patients with new-onset AF on mortality, hospitalizations, or emergency room (ER) visits compared to rate control strategy.

Methods:

Retrospective observational study of patients at least 18 years of age diagnosed with new-onset AF cared for in a large United States healthcare system. Patients with identifiable triggers were excluded. The primary outcome was rates of all-cause mortality, hospitalization, or ER visit for AF, atrial flutter (AFL), or HF at 30 days.

Results:

Four hundred sixty-three patients were included, 278 in the rate control group and 185 in the rhythm control group. The median follow-up duration across groups was 654.5 days. At 30 days post-diagnosis, the rate control group experienced a higher rate of the primary outcome (19.8% vs. 11.9%, P = 0.027). Cox proportional hazards model demonstrated that rhythm control was associated with a reduced risk of experiencing the secondary outcome (HR 0.759, 95% CI [0.582, 0.984], P = 0.042).

Conclusion and Relevance:

In patients with new-onset AF, early rhythm control was associated with a lower incidence of all-cause mortality, hospitalization, or ER visits. These findings underscore the importance of rhythm control in optimizing early AF management and improving patient outcomes.