Copyright © 2003 by the European Society of Cardiology.
Regular Articles
Impact of rate versus rhythm control on quality of life in patients with persistent atrial fibrillation
Results from a prospective randomized study
a J.W. Goethe University, Department of Medicine, Division of Cardiology, Frankfurt, Germany
b Datamap GmbH, Freiburg, Germany
c St. Georg Hospital, Hamburg, Germany
* Correspondence to: Stefan H. Hohnloser, MD, FESC, FACC, J.W. Goethe University, Dept. of Medicine, Division of Cardiology, Theodor-Stern-Kai 7, 60590 Frankfurt am Main. Tel.: +49.69.6301-7404; fax: +49.69.6301-7017
E-mail address: hohnloser{at}em.uni-frankfurt.de
Received 19 January 2003; revised 10 March 2003; accepted 9 April 2003
Aims Despite the high prevalence of atrial fibrillation (AF), there are only limited data on quality of life (QoL) stemming from prospective trials comparing rate versus rhythm control. This prospective study evaluated QoL in patients with symptomatic persistent AF randomized to therapy aiming at rate versus rhythm control.
Methods and results Patients with symptomatic persistent AF (7 to 360 days duration) were prospectively randomized to ventricular rate control (n=125) or to cardioversion and maintenance of sinus rhythm (n=127). QoL was assessed by the Medical Outcomes Study Short Form health survey (SF-36) at baseline and during 1 year of follow-up. Changes in QoL were compared on an intent-to-treat basis, and subsequently between patients in sinus rhythm versus AF. At baseline, all SF-36 scales were reduced compared to healthy controls. At 1 year, six of eight items had improved significantly in patients assigned to rate control, and five of eight items on rhythm control (p=ns). The physical component summary showed a comparable increase with both treatment strategies (rate control: p=0.004; rhythm control: p<0.001) whereas no significant changes were found for the mental component summary. At 1 year, 55% of patients reported a positive health transition with no inter-group differences. There were no significant differences in QoL in patients in sinus rhythm or AF at the end of the observation period.
Conclusion In patients with symptomatic persistent AF, the two treatment strategies of rate versus rhythm control are associated with similar improvements in QoL.
Key Words: Atrial fibrillation • Quality of life • Controlled clinical trials
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  T. R Betts Is rate more important than rhythm in treating atrial fibrillation? Yes BMJ, August 21, 2009; 339(aug21_1): b3173 - b3173. [Full Text]
|
|
|
|
 |
|
 P. Dorian, P. G. Guerra, C. R. Kerr, S. S. O'Donnell, E. Crystal, A. M. Gillis, L. B. Mitchell, D. Roy, A. C. Skanes, M. S. Rose, et al. Validation of a New Simple Scale to Measure Symptoms in Atrial Fibrillation: The Canadian Cardiovascular Society Severity in Atrial Fibrillation Scale Circ Arrhythm Electrophysiol, June 1, 2009; 2(3): 218 - 224. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Bajpai, I. Savelieva, and A. J. Camm Treatment of atrial fibrillation Br. Med. Bull., December 5, 2008; (2008) ldn046v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A J Camm, I Savelieva, G Y H Lip, and on behalf of the Guideline Development Group for t Rate control in the medical management of atrial fibrillation Heart, January 1, 2007; 93(1): 35 - 38. [Full Text] [PDF]
|
|
|
|
 |
|
 Writing Committee Members, V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Europace, September 1, 2006; 8(9): 651 - 745. [Full Text] [PDF]
|
|
|
|
|
|
A Nergardh and M Frick Perceived heart rhythm in relation to ECG findings after direct current cardioversion of atrial fibrillation Heart, September 1, 2006; 92(9): 1244 - 1247. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society J. Am. Coll. Cardiol., August 15, 2006; 48(4): 854 - 906. [Full Text] [PDF]
|
|
|
|
|
|
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society J. Am. Coll. Cardiol., August 15, 2006; 48(4): e149 - e246. [Full Text] [PDF]
|
|
|
|
 |
|
 V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society Circulation, August 15, 2006; 114(7): e257 - e354. [Full Text] [PDF]
|
|
|
|
|
|
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society Circulation, August 15, 2006; 114(7): 700 - 752. [Full Text] [PDF]
|
|
|
|
 |
|
 Authors/Task Force Members, V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation executive summary: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Eur. Heart J., August 2, 2006; 27(16): 1979 - 2030. [Full Text] [PDF]
|
|
|
|
|
|
C. J. Boos, R. A. Anderson, and G. Y.H. Lip Is atrial fibrillation an inflammatory disorder? Eur. Heart J., January 2, 2006; 27(2): 136 - 149. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Testa, G. G.L. Biondi-Zoccai, A. D. Russo, F. Bellocci, F. Andreotti, and F. Crea Rate-control vs. rhythm-control in patients with atrial fibrillation: a meta-analysis Eur. Heart J., October 1, 2005; 26(19): 2000 - 2006. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. G. Futterman and L. Lemberg Atrial Fibrillation Am. J. Crit. Care., September 1, 2005; 14(5): 438 - 440. [Full Text] [PDF]
|
|
|
|
|
|
R. H. Falk Rate Control Is Preferable to Rhythm Control in the Majority of Patients With Atrial Fibrillation Circulation, June 14, 2005; 111(23): 3141 - 3150. [Full Text] [PDF]
|
|
|
|
|
|
P. Zohar, M. Kovacic, M. Brezocnik, and M. Podbregar Prediction of maintenance of sinus rhythm after electrical cardioversion of atrial fibrillation by non-deterministic modelling Europace, January 1, 2005; 7(5): 500 - 507. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Marshall, A. R. Levy, H. Vidaillet, E. Fenwick, A. Slee, G. Blackhouse, H. L. Greene, D. G. Wyse, G. Nichol, B. J. O'Brien, et al. Cost-Effectiveness of Rhythm versus Rate Control in Atrial Fibrillation Ann Intern Med, November 2, 2004; 141(9): 653 - 661. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Dorian, I. Mangat, A. Pinter, and V. Korley The Burden of Atrial Fibrillation: Should We Abandon Antiarrhythmic Drug Therapy? Journal of Cardiovascular Pharmacology and Therapeutics, October 1, 2004; 9(4): 257 - 262. [Abstract] [PDF]
|
|
|
|
|
|
V. E. Hagens, K. M. Vermeulen, E. M. TenVergert, D. J. Van Veldhuisen, H. A. Bosker, O. Kamp, J. H. Kingma, J. G.P. Tijssen, H. J.G.M. Crijns, I. C. Van Gelder, et al. Rate control is more cost-effective than rhythm control for patients with persistent atrial fibrillation -- results from the RAte Control versus Electrical cardioversion (RACE) study Eur. Heart J., September 1, 2004; 25(17): 1542 - 1549. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. W. Israel, G. Gronefeld, J. R. Ehrlich, Y.-G. Li, and S. H. Hohnloser Long-term risk of recurrent atrial fibrillation as documented by an implantable monitoring device: Implications for optimal patient care J. Am. Coll. Cardiol., January 7, 2004; 43(1): 47 - 52. [Abstract] [Full Text] [PDF]
|
|