Little is known about the use of pharmacologic rhythm
or rate control in younger atrial fibrillation (AF) patients in clinical
practice. Using commercial health data from 2006 through 2010, patients aged
<65 years with an initial AF encounter were categorized as receiving
pharmacologic rhythm- or rate-control treatment. Factors associated with each treatment
were determined. Cox models with inverse propensity-weighted estimators were
used to compare times to AF, heart failure, cardiovascular, non-cardiovascular,
and any-cause hospitalizations. Of 79,232 patients meeting the study criteria, 12,408
(16%) received a rhythm-control drug and 66,824 (84%) received only rate-controlling
drugs. Only 2% and 0.1%, respectively, received electrical cardioversion and AF
ablation during the initial AF encounter. Patients who were men (OR 1.10, 95%
CI 1.06–1.15), had index encounters in later years (2010 versus 2006: OR 1.34, 95%
CI 1.23–1.45), were in the southern United States, and had other cardiac
comorbidities were more likely to receive a rhythm-control drug. There was a
greater risk of AF (HR 1.40, 95% CI 1.31–1.50), cardiovascular (HR 1.26, 95% CI
1.20–1.33), and all-cause (HR 1.11, 95% CI 1.07–1.16) hospitalizations in the
rhythm-control group, but there was no difference between groups in heart
failure (HR 1.01, 95% CI 0.88–1.17) or non-cardiovascular (HR 1.04, 95% CI 0.99–1.09)
hospitalizations. Among younger AF patients receiving initial pharmacologic treatment,
antiarrhythmic drugs were used less frequently than only rate-controlling drugs,
and were associated with a higher risk of subsequent hospitalization.
Credits: Nancy M. Allen LaPointe; Yuliya Lokhnygina; Jacqueline Rimmler; Gillian D. Sanders; Eric D. Peterson; Sana M. Al-Khatib