File Download
  Links for fulltext
     (May Require Subscription)
Supplementary

Article: Rhythm vs. rate control of atrial fibrillation meta-analysed by number needed to treat

TitleRhythm vs. rate control of atrial fibrillation meta-analysed by number needed to treat
Authors
KeywordsAtrial fibrillation
Meta-analysis
NNT
Rate control
Rhythm control
Issue Date2005
PublisherBlackwell Publishing Ltd. The Journal's web site is located at http://www.blackwellpublishing.com/journals/BJCP
Citation
British Journal Of Clinical Pharmacology, 2005, v. 60 n. 4, p. 347-354 How to Cite?
AbstractBackground: Whenever feasible, rhythm control of atrial fibrillation (AF) was generally preferred over rate control, in the belief that it offered better symptomatic relief and quality of life, and eliminated the need for anticoagulation. However, recent trials appear to challenge these assumptions. Aims: To explore the desirability of rhythm vs. rate control of AF by systematic review of pertinent, published, randomized controlled trials (RCTs) and a meta-analysis by number needed to treat (NNT) year -1, with respect to diverse clinically important outcomes. Methods: RCTs of outcome primarily comparing rate vs. rhythm control in patients with spontaneous AF were identified. For each outcome and assuming rhythm control to be the active treatment, relative risk reduction (RRR) and NNT year -1 were derived for individual trials together with an NNT year -1 for all trials combined; corresponding 95% confidence intervals (CI) were also calculated. Adverse drug reaction (ADR) and quality of life reporting were also assessed. Results: In all, data from five suitable RCTs (entailing 5239 patients) were analysed. For hospitalization, available RRRs and NNT year -1 values were all clinically and statistically significant. Overall, one additional patient was hospitalized for every 35 assigned to rhythm control (95% CI 27, 48). For the endpoints of death, 'ischaemic' stroke and 'non-CNS' bleeding, there was no significant difference. ADRs were significantly more common in rhythm control patients, whereas quality of life assessments revealed no difference. Thromboembolism was associated with cessation of or subtherapeutic anticoagulation, irrespective of treatment assignment. Conclusion: Reduced risk of hospitalization and non-inferiority for other endpoints all favour rate control, the less costly strategy. If symptoms of AF are not a problem, treatment should target optimizing rate control and more widespread and effective prophylactic anticoagulation. © 2005 Blackwell Publishing Ltd.
Persistent Identifierhttp://hdl.handle.net/10722/49043
ISSN
2014 Impact Factor: 3.878
2014 SCImago Journal Rankings: 1.277
PubMed Central ID
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorKumana, CRen_HK
dc.contributor.authorCheung, BMYen_HK
dc.contributor.authorCheung, GTYen_HK
dc.contributor.authorOvedal, Ten_HK
dc.contributor.authorPederson, Ben_HK
dc.contributor.authorLauder, IJen_HK
dc.date.accessioned2008-06-12T06:33:11Z-
dc.date.available2008-06-12T06:33:11Z-
dc.date.issued2005en_HK
dc.identifier.citationBritish Journal Of Clinical Pharmacology, 2005, v. 60 n. 4, p. 347-354en_HK
dc.identifier.issn0306-5251en_HK
dc.identifier.urihttp://hdl.handle.net/10722/49043-
dc.description.abstractBackground: Whenever feasible, rhythm control of atrial fibrillation (AF) was generally preferred over rate control, in the belief that it offered better symptomatic relief and quality of life, and eliminated the need for anticoagulation. However, recent trials appear to challenge these assumptions. Aims: To explore the desirability of rhythm vs. rate control of AF by systematic review of pertinent, published, randomized controlled trials (RCTs) and a meta-analysis by number needed to treat (NNT) year -1, with respect to diverse clinically important outcomes. Methods: RCTs of outcome primarily comparing rate vs. rhythm control in patients with spontaneous AF were identified. For each outcome and assuming rhythm control to be the active treatment, relative risk reduction (RRR) and NNT year -1 were derived for individual trials together with an NNT year -1 for all trials combined; corresponding 95% confidence intervals (CI) were also calculated. Adverse drug reaction (ADR) and quality of life reporting were also assessed. Results: In all, data from five suitable RCTs (entailing 5239 patients) were analysed. For hospitalization, available RRRs and NNT year -1 values were all clinically and statistically significant. Overall, one additional patient was hospitalized for every 35 assigned to rhythm control (95% CI 27, 48). For the endpoints of death, 'ischaemic' stroke and 'non-CNS' bleeding, there was no significant difference. ADRs were significantly more common in rhythm control patients, whereas quality of life assessments revealed no difference. Thromboembolism was associated with cessation of or subtherapeutic anticoagulation, irrespective of treatment assignment. Conclusion: Reduced risk of hospitalization and non-inferiority for other endpoints all favour rate control, the less costly strategy. If symptoms of AF are not a problem, treatment should target optimizing rate control and more widespread and effective prophylactic anticoagulation. © 2005 Blackwell Publishing Ltd.en_HK
dc.format.extent388 bytes-
dc.format.mimetypetext/html-
dc.languageengen_HK
dc.publisherBlackwell Publishing Ltd. The Journal's web site is located at http://www.blackwellpublishing.com/journals/BJCPen_HK
dc.relation.ispartofBritish Journal of Clinical Pharmacologyen_HK
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.rightsBritish Journal of Clinical Pharmacology. Copyright © Blackwell Publishing Ltd.en_HK
dc.rightsThe definitive version is available at www.blackwell-synergy.comen_HK
dc.subjectAtrial fibrillationen_HK
dc.subjectMeta-analysisen_HK
dc.subjectNNTen_HK
dc.subjectRate controlen_HK
dc.subjectRhythm controlen_HK
dc.titleRhythm vs. rate control of atrial fibrillation meta-analysed by number needed to treaten_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0306-5251&volume=60&issue=4&spage=347&epage=54&date=2005&atitle=Rhythm+vs.+rate+control+of+atrial+fibrillation+meta-analysed+by+number+needed+to+treaten_HK
dc.identifier.emailCheung, BMY:mycheung@hku.hken_HK
dc.identifier.authorityCheung, BMY=rp01321en_HK
dc.description.naturepublished_or_final_versionen_HK
dc.identifier.doi10.1111/j.1365-2125.2005.02449.xen_HK
dc.identifier.pmid16187966-
dc.identifier.pmcidPMC1884833en_HK
dc.identifier.scopuseid_2-s2.0-26444611184en_HK
dc.identifier.hkuros108593-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-26444611184&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume60en_HK
dc.identifier.issue4en_HK
dc.identifier.spage347en_HK
dc.identifier.epage354en_HK
dc.identifier.isiWOS:000232140100002-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridKumana, CR=7005112381en_HK
dc.identifier.scopusauthoridCheung, BMY=7103294806en_HK
dc.identifier.scopusauthoridCheung, GTY=55108882600en_HK
dc.identifier.scopusauthoridOvedal, T=8925157800en_HK
dc.identifier.scopusauthoridPederson, B=8925157900en_HK
dc.identifier.scopusauthoridLauder, IJ=35564928000en_HK
dc.identifier.citeulike333213-

Export via OAI-PMH Interface in XML Formats


OR


Export to Other Non-XML Formats