Generalizability of the EAST-AFNET 4 Trial: Assessing Outcomes of Early Rhythm-Control Therapy in Patients With Atrial Fibrillation
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Generalizability of the EAST-AFNET 4 Trial: Assessing Outcomes of Early Rhythm-Control Therapy in Patients With Atrial Fibrillation : Assessing Outcomes of Early Rhythm-Control Therapy in Patients With Atrial Fibrillation. / Dickow, Jannis; Kirchhof, Paulus; Van Houten, Holly K; Sangaralingham, Lindsey R; Dinshaw, Leon H W; Friedman, Paul A; Packer, Douglas L; Noseworthy, Peter A; Yao, Xiaoxi.
In: J AM HEART ASSOC, Vol. 11, No. 11, e024214, 07.06.2022.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Generalizability of the EAST-AFNET 4 Trial: Assessing Outcomes of Early Rhythm-Control Therapy in Patients With Atrial Fibrillation
T2 - Assessing Outcomes of Early Rhythm-Control Therapy in Patients With Atrial Fibrillation
AU - Dickow, Jannis
AU - Kirchhof, Paulus
AU - Van Houten, Holly K
AU - Sangaralingham, Lindsey R
AU - Dinshaw, Leon H W
AU - Friedman, Paul A
AU - Packer, Douglas L
AU - Noseworthy, Peter A
AU - Yao, Xiaoxi
PY - 2022/6/7
Y1 - 2022/6/7
N2 - Background EAST-AFNET 4 (Early Treatment of Atrial Fibrillation for Stroke Prevention Trial) demonstrated clinical benefit of early rhythm-control therapy (ERC) in patients with new-onset atrial fibrillation (AF) and concomitant cardiovascular conditions compared with current guideline-based practice. This study aimed to evaluate the generalizability of EAST-AFNET 4 in routine practice. Methods and Results Using a US administrative database, we identified 109 739 patients with newly diagnosed AF during the enrollment period of EAST-AFNET 4. Patients were classified as either receiving ERC, using AF ablation or antiarrhythmic drug therapy, within the first year after AF diagnosis (n=27 106) or not receiving ERC (control group, n=82 633). After propensity score overlap weighting, Cox proportional hazards regression was used to compare groups for the primary composite outcome of all-cause mortality, stroke, or hospitalization with the diagnoses heart failure or myocardial infarction. Most patients (79 948 of 109 739; 72.9%) met the inclusion criteria for EAST-AFNET 4. ERC was associated with a reduced risk for the primary composite outcome (hazard ratio [HR], 0.85; 95% CI, 0.75-0.97 [P=0.02]) with largely consistent results between eligible (HR, 0.89; 95% CI, 0.76-1.04 [P=0.14]) or ineligible (HR, 0.77; 95% CI, 0.60-0.98 [P=0.04]) patients for EAST-AFNET 4 trial inclusion. ERC was associated with lower risk of stroke in the overall cohort and in trial-eligible patients. Conclusions This analysis replicates the clinical benefit of ERC seen in EAST-AFNET 4. The results support adoption of ERC as part of the management of recently diagnosed AF in the United States.
AB - Background EAST-AFNET 4 (Early Treatment of Atrial Fibrillation for Stroke Prevention Trial) demonstrated clinical benefit of early rhythm-control therapy (ERC) in patients with new-onset atrial fibrillation (AF) and concomitant cardiovascular conditions compared with current guideline-based practice. This study aimed to evaluate the generalizability of EAST-AFNET 4 in routine practice. Methods and Results Using a US administrative database, we identified 109 739 patients with newly diagnosed AF during the enrollment period of EAST-AFNET 4. Patients were classified as either receiving ERC, using AF ablation or antiarrhythmic drug therapy, within the first year after AF diagnosis (n=27 106) or not receiving ERC (control group, n=82 633). After propensity score overlap weighting, Cox proportional hazards regression was used to compare groups for the primary composite outcome of all-cause mortality, stroke, or hospitalization with the diagnoses heart failure or myocardial infarction. Most patients (79 948 of 109 739; 72.9%) met the inclusion criteria for EAST-AFNET 4. ERC was associated with a reduced risk for the primary composite outcome (hazard ratio [HR], 0.85; 95% CI, 0.75-0.97 [P=0.02]) with largely consistent results between eligible (HR, 0.89; 95% CI, 0.76-1.04 [P=0.14]) or ineligible (HR, 0.77; 95% CI, 0.60-0.98 [P=0.04]) patients for EAST-AFNET 4 trial inclusion. ERC was associated with lower risk of stroke in the overall cohort and in trial-eligible patients. Conclusions This analysis replicates the clinical benefit of ERC seen in EAST-AFNET 4. The results support adoption of ERC as part of the management of recently diagnosed AF in the United States.
KW - Anti-Arrhythmia Agents/therapeutic use
KW - Atrial Fibrillation/drug therapy
KW - Catheter Ablation
KW - Humans
KW - Secondary Prevention
KW - Stroke/epidemiology
KW - United States/epidemiology
U2 - 10.1161/JAHA.121.024214
DO - 10.1161/JAHA.121.024214
M3 - SCORING: Journal article
C2 - 35621202
VL - 11
JO - J AM HEART ASSOC
JF - J AM HEART ASSOC
SN - 2047-9980
IS - 11
M1 - e024214
ER -