File Download
 
Links for fulltext
(May Require Subscription)
 
Supplementary

Article: Rhythm vs. rate control of atrial fibrillation meta-analysed by number needed to treat
  • Basic View
  • Metadata View
  • XML View
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
2012 Impact Factor: 3.578
2012 SCImago Journal Rankings: 1.150
 
DOIhttp://dx.doi.org/10.1111/j.1365-2125.2005.02449.x
 
PubMed Central IDPMC1884833
 
ISI Accession Number IDWOS:000232140100002
 
ReferencesReferences in Scopus
 
DC FieldValue
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
2012 Impact Factor: 3.578
2012 SCImago Journal Rankings: 1.150
 
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
 
<?xml encoding="utf-8" version="1.0"?>
<item><contributor.author>Kumana, CR</contributor.author>
<contributor.author>Cheung, BMY</contributor.author>
<contributor.author>Cheung, GTY</contributor.author>
<contributor.author>Ovedal, T</contributor.author>
<contributor.author>Pederson, B</contributor.author>
<contributor.author>Lauder, IJ</contributor.author>
<date.accessioned>2008-06-12T06:33:11Z</date.accessioned>
<date.available>2008-06-12T06:33:11Z</date.available>
<date.issued>2005</date.issued>
<identifier.citation>British Journal Of Clinical Pharmacology, 2005, v. 60 n. 4, p. 347-354</identifier.citation>
<identifier.issn>0306-5251</identifier.issn>
<identifier.uri>http://hdl.handle.net/10722/49043</identifier.uri>
<description.abstract>Background: 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, &apos;ischaemic&apos; stroke and &apos;non-CNS&apos; 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. &#169; 2005 Blackwell Publishing Ltd.</description.abstract>
<format.extent>388 bytes</format.extent>
<format.mimetype>text/html</format.mimetype>
<language>eng</language>
<publisher>Blackwell Publishing Ltd. The Journal&apos;s web site is located at http://www.blackwellpublishing.com/journals/BJCP</publisher>
<relation.ispartof>British Journal of Clinical Pharmacology</relation.ispartof>
<rights>British Journal of Clinical Pharmacology. Copyright &#169; Blackwell Publishing Ltd.</rights>
<rights>Creative Commons: Attribution 3.0 Hong Kong License</rights>
<rights>The definitive version is available at www.blackwell-synergy.com</rights>
<subject>Atrial fibrillation</subject>
<subject>Meta-analysis</subject>
<subject>NNT</subject>
<subject>Rate control</subject>
<subject>Rhythm control</subject>
<title>Rhythm vs. rate control of atrial fibrillation meta-analysed by number needed to treat</title>
<type>Article</type>
<identifier.openurl>http://library.hku.hk:4550/resserv?sid=HKU:IR&amp;issn=0306-5251&amp;volume=60&amp;issue=4&amp;spage=347&amp;epage=54&amp;date=2005&amp;atitle=Rhythm+vs.+rate+control+of+atrial+fibrillation+meta-analysed+by+number+needed+to+treat</identifier.openurl>
<description.nature>published_or_final_version</description.nature>
<identifier.doi>10.1111/j.1365-2125.2005.02449.x</identifier.doi>
<identifier.pmid>16187966</identifier.pmid>
<identifier.pmcid>PMC1884833</identifier.pmcid>
<identifier.scopus>eid_2-s2.0-26444611184</identifier.scopus>
<identifier.hkuros>108593</identifier.hkuros>
<relation.references>http://www.scopus.com/mlt/select.url?eid=2-s2.0-26444611184&amp;selection=ref&amp;src=s&amp;origin=recordpage</relation.references>
<identifier.volume>60</identifier.volume>
<identifier.issue>4</identifier.issue>
<identifier.spage>347</identifier.spage>
<identifier.epage>354</identifier.epage>
<identifier.isi>WOS:000232140100002</identifier.isi>
<publisher.place>United Kingdom</publisher.place>
<identifier.citeulike>333213</identifier.citeulike>
<bitstream.url>http://hub.hku.hk/bitstream/10722/49043/1/108593.htm</bitstream.url>
</item>
Author Affiliations
  1. The University of Hong Kong