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Outcomes of Rate-Control Treatment in Patients With Atrial Fibrillation and Heart Failure - A Nationwide Cohort Study.

Outcomes of Rate-Control Treatment in Patients With Atrial Fibrillation and Heart Failure - A Nationwide Cohort Study.
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Yu HT, Yang PS, Lee H, You SC, Kim TH, Uhm JS, Kim JY, Pak HN, Lee MH, Joung B,


Yu HT, Yang PS, Lee H, You SC, Kim TH, Uhm JS, Kim JY, Pak HN, Lee MH, Joung B, (click to view)

Yu HT, Yang PS, Lee H, You SC, Kim TH, Uhm JS, Kim JY, Pak HN, Lee MH, Joung B,

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Circulation journal : official journal of the Japanese Circulation Society 2017 11 14() doi 10.1253/circj.CJ-17-0669
Abstract
BACKGROUND
Rate control is now a front-line therapy in the management of atrial fibrillation (AF). However, the survival benefits of different rate-control medications remain controversial, so we assessed the efficacy of rate-control medications in AF patients with concomitant heart failure (HF).Methods and Results:From January 2002 to December 2008, a total of 7,034 AF patients with a single type of rate-control drug or without rate-control treatment were enrolled from the Korea National Health Insurance Service database. The death rates over a mean follow-up of 4.5±1.2 years were 12.6% (580 of 4,593) and 29.0% (709 of 2,441) in non-HF and HF patients, respectively. Among the total subjects, the risk of death was lower in patients receiving β-blockers (adjusted hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.64-0.88) and calcium-channel blockers (adjusted HR 0.74, 95% CI 0.55-0.98) compared with those who did not receive rate-control medications. In patients without HF, use of rate-control medications did not affect the risk of death. In patients with HF, β-blockers significantly decreased the mortality risk (adjusted HR 0.63, 95% CI 0.50-0.79), whereas use of calcium-channel blockers or digoxin was not associated with death. The results were observed consistently among the cohorts after propensity matching.

CONCLUSIONS
Use of β-blockers was associated with a reduced mortality rate for AF patient with HF but not for those without HF. These findings should be examined in a large randomized trial.

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