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

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TitleRhythm vs. rate control of atrial fibrillation meta-analysed by number needed to treat
AuthorsKumana, CR1
Cheung, BMY
Cheung, GTY
Ovedal, T
Pederson, B
Lauder, IJ1
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
CitationBritish Journal Of Clinical Pharmacology, 2005, v. 60 n. 4, p. 347-354 [How to Cite?]
DOI: http://dx.doi.org/10.1111/j.1365-2125.2005.02449.x
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.
ISSN0306-5251
2011 Impact Factor: 2.958
2011 SCImago Journal Rankings: 0.231
DOIhttp://dx.doi.org/10.1111/j.1365-2125.2005.02449.x
ISI Accession Number IDWOS:000232140100002
PubMed Central IDPMC1884833
ReferencesReferences in Scopus
DC Field
Value
dc.contributor.authorKumana, CR
dc.contributor.authorCheung, BMY
dc.contributor.authorCheung, GTY
dc.contributor.authorOvedal, T
dc.contributor.authorPederson, B
dc.contributor.authorLauder, IJ
dc.date.accessioned2008-06-12T06:33:11Z
dc.date.available2008-06-12T06:33:11Z
dc.date.issued2005
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.
dc.description.naturepublished_or_final_version
dc.format.extent388 bytes
dc.format.mimetypetext/html
dc.identifier.citationBritish Journal Of Clinical Pharmacology, 2005, v. 60 n. 4, p. 347-354 [How to Cite?]
DOI: http://dx.doi.org/10.1111/j.1365-2125.2005.02449.x
dc.identifier.citeulike333213
dc.identifier.doihttp://dx.doi.org/10.1111/j.1365-2125.2005.02449.x
dc.identifier.epage354
dc.identifier.hkuros108593
dc.identifier.isiWOS:000232140100002
dc.identifier.issn0306-5251
2011 Impact Factor: 2.958
2011 SCImago Journal Rankings: 0.231
dc.identifier.issue4
dc.identifier.openurl
dc.identifier.pmcidPMC1884833
dc.identifier.pmid16187966
dc.identifier.scopuseid_2-s2.0-26444611184
dc.identifier.spage347
dc.identifier.urihttp://hdl.handle.net/10722/49043
dc.identifier.volume60
dc.languageeng
dc.publisherBlackwell Publishing Ltd. The Journal's web site is located at http://www.blackwellpublishing.com/journals/BJCP
dc.publisher.placeUnited Kingdom
dc.relation.ispartofBritish Journal of Clinical Pharmacology
dc.relation.referencesReferences in Scopus
dc.rightsBritish Journal of Clinical Pharmacology. Copyright © Blackwell Publishing Ltd.
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License
dc.rightsThe definitive version is available at www.blackwell-synergy.com
dc.subjectAtrial fibrillation
dc.subjectMeta-analysis
dc.subjectNNT
dc.subjectRate control
dc.subjectRhythm control
dc.titleRhythm vs. rate control of atrial fibrillation meta-analysed by number needed to treat
dc.typeArticle
Author Affiliations
  1. The University of Hong Kong