For patients with atrial fibrillation (AF) and signs and symptoms of HF, early rhythm control (ERC) therapy reduces cardiovascular events, according to a study published in Circulation. Researchers conducted a prespecified subanalysis of the randomized EAST-AFNET 4 trial, which compared the effect of systematic ERC therapy with usual care for AF in nearly 800 adults with HF. During a median follow-up of 5.1 years, the composite primary outcomes of cardiovascular death, stroke, or hospitalization for worsening of HF or for acute coronary syndrome occurred in 5.7 patients per 100 patient-years in the ERC group, compared with 7.9 per 100 patient-years in the usual care group (HR, 0.74; 95% CI, 0.56-0.97); there was no alteration by HF status. The primary safety outcome of death, stroke, or serious adverse events related to rhythm control therapy occurred in 17.9% and 21.6% of patients randomly assigned to ERC and usual care, respectively (HR, 0.85; 95% CI, 0.62-1.17). Improvement in left ventricular ejection fraction was seen in both groups. The composite outcome of death or hospitalization for worsening of HF was improved by ERC. “Clinical benefit is observed across the spectrum of heart failure sub types, suggesting that restoring and maintaining sinus rhythm via rhythm control therapy conveys the clinical benefit,” the authors wrote.
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