Control of AF ‘still not optimal’
MedWire News: Data from the RealiseAF registry have shown that control of atrial fibrillation (AF) is still not optimal, with patients frequently experiencing symptoms, functional impairment, and an altered quality of life (QoL) even when they are receiving recommended treatments.
The burden of AF also includes frequent hospital admissions for cardiovascular events and a higher requirement for procedures, report P Gabriel Steg (Université Paris VII, France) and co-authors in the journal Heart.
Improved treatment of AF patients is needed to minimize the number of those with uncontrolled AF, reduce functional impairment and occurrence of symptoms, and improve overall QoL, they add.
The researchers investigated whether rate control of AF (resting ventricular heart rate ≤80 beats per minute [BPM]) or rhythm control (in sinus rhythm) at baseline resting electrocardiogram achieved better clinical outcomes in 9665 AF patients. They also described the cardiovascular risk profile of these patients.
Overall, 59.0% of the patients had controlled AF, 26.5% of whom were rhythm controlled, and 32.5% of whom were rate controlled. The remainder of the patients (41.0%) had uncontrolled AF.
Symptoms such as palpitations, dyspnea, and fatigue during the week before enrollment were fairly common, in those with controlled AF, at 55.7%, albeit less so than in the uncontrolled AF patients, at 68.4% (p<0.001). Symptom prevalence did not differ significantly according to type of AF control.
At baseline, AF-related functional impairment (European Heart Rhythm Association class >1 for arrhythmia-related symptoms) was also common in patients with controlled AF, again at a lesser extent, (67.4%), compared with uncontrolled AF patients at 82.1% (p<0.001).
In addition, controlled AF patients had a better QoL (reported by the EuroQOL Visual Analog Scale, where a score of 100 denotes best imaginable health state and 0 denotes worst) at a mean score of 67.1, than those with uncontrolled AF, who had a mean score of 63.2 (p<0.001).
The researchers note that patients who were rhythm controlled had the highest quality of life, those who were rate controlled an intermediate QoL, and those with a heart rate >80 bpm the lowest QoL.
Regardless of whether their condition was controlled or not, 28.1% of patients overall were hospitalized for a cardiovascular event such as ischemic attack, stroke, or pulmonary embolism, in the 12 months before they were enrolled in the trial.
"The enormous burden of AF shown by symptoms, QoL, cardiovascular events, hospitalizations, procedures, and their attendant costs, emphasizes the need for improved treatments for this increasingly common condition," the authors conclude.
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By Piriya Mahendra