Tze-Fan Chao1, Chia-Jen Liu1, Ta-Chuan Tuan1, Su-Jung Chen1, Kang-Ling Wang1, Yenn-Jiang Lin1, Shih-Lin Chang1, Li-Wei Lo1, Yu-Feng Hu1, Tzeng-Ji Chen1, Chern-En Chiang2, Shih-Ann Chen2. 1. From Division of Cardiology, Department of Medicine (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.), Division of Hematology and Oncology, Department of Medicine (C.-J.L.), Division of Infectious Diseases, Department of Medicine (S.-J.C.), Department of Family Medicine (T.-J.C.), General Clinical Research Center (C.E.C.), and Department of Medical Research and Education (C.E.C.), Taipei Veterans General Hospital, Taipei, Taiwan; and Institute of Clinical Medicine and Cardiovascular Research Center (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.) and Institute of Public Health and School of Medicine (C.-J.L., S.-J.C.), National Yang-Ming University, Taipei, Taiwan. 2. From Division of Cardiology, Department of Medicine (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.), Division of Hematology and Oncology, Department of Medicine (C.-J.L.), Division of Infectious Diseases, Department of Medicine (S.-J.C.), Department of Family Medicine (T.-J.C.), General Clinical Research Center (C.E.C.), and Department of Medical Research and Education (C.E.C.), Taipei Veterans General Hospital, Taipei, Taiwan; and Institute of Clinical Medicine and Cardiovascular Research Center (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.) and Institute of Public Health and School of Medicine (C.-J.L., S.-J.C.), National Yang-Ming University, Taipei, Taiwan. cechiang@vghtpe.gov.tw epsachen@ms41.hinet.net.
Abstract
BACKGROUND: Current American and European guidelines emphasize the importance of rate-control treatments in treating atrial fibrillation with a Class I recommendation, although data on the survival benefits of rate control are lacking. The goal of the present study was to investigate whether patients receiving rate-control drugs had a better prognosis compared with those without rate-control treatment. METHODS AND RESULTS: This study used the National Health Insurance Research Database in Taiwan. There were 43 879, 18 466, and 38 898 patients with atrial fibrillation enrolled in the groups receiving β-blockers, calcium channel blockers, and digoxin, respectively. The reference group consisted of 168 678 subjects who did not receive any rate-control drug. The clinical end point was all-cause mortality. During a follow-up of 4.9±3.7 years, mortality occurred in 88 263 patients (32.7%). After adjustment for baseline differences, the risk of mortality was lower in patients receiving β-blockers (adjusted hazard ratio=0.76; 95% confidence interval=0.74-0.78) and calcium channel blockers (adjusted hazard ratio=0.93; 95% confidence interval=0.90-0.96) compared with those who did not receive rate-control medications. On the contrary, the digoxin group had a higher risk of mortality with an adjusted hazard ratio of 1.12 (95% confidence interval=1.10-1.14). The results were observed consistently in subgroup analyses and among the cohorts after propensity matching. CONCLUSIONS: In this nationwide atrial fibrillation cohort, the risk of mortality was lower for patients receiving rate-control treatment with β-blockers or calcium channel blockers, and the use of β-blockers was associated with the largest risk reduction. Digoxin use was associated with greater mortality. Prospective, randomized trials are necessary to confirm these findings.
BACKGROUND: Current American and European guidelines emphasize the importance of rate-control treatments in treating atrial fibrillation with a Class I recommendation, although data on the survival benefits of rate control are lacking. The goal of the present study was to investigate whether patients receiving rate-control drugs had a better prognosis compared with those without rate-control treatment. METHODS AND RESULTS: This study used the National Health Insurance Research Database in Taiwan. There were 43 879, 18 466, and 38 898 patients with atrial fibrillation enrolled in the groups receiving β-blockers, calcium channel blockers, and digoxin, respectively. The reference group consisted of 168 678 subjects who did not receive any rate-control drug. The clinical end point was all-cause mortality. During a follow-up of 4.9±3.7 years, mortality occurred in 88 263 patients (32.7%). After adjustment for baseline differences, the risk of mortality was lower in patients receiving β-blockers (adjusted hazard ratio=0.76; 95% confidence interval=0.74-0.78) and calcium channel blockers (adjusted hazard ratio=0.93; 95% confidence interval=0.90-0.96) compared with those who did not receive rate-control medications. On the contrary, the digoxin group had a higher risk of mortality with an adjusted hazard ratio of 1.12 (95% confidence interval=1.10-1.14). The results were observed consistently in subgroup analyses and among the cohorts after propensity matching. CONCLUSIONS: In this nationwide atrial fibrillation cohort, the risk of mortality was lower for patients receiving rate-control treatment with β-blockers or calcium channel blockers, and the use of β-blockers was associated with the largest risk reduction. Digoxin use was associated with greater mortality. Prospective, randomized trials are necessary to confirm these findings.