Acute Care/Hospitalization

Hospitals use rhythm- and rate-control strategies for patients diagnosed with atrial fibrillation equally

Patients diagnosed with atrial fibrillation (AF)—a typically rapid, irregular heart rhythm—are treated with one of two different strategies. One strategy uses drugs or procedures to restore and attempt to maintain a normal heart rhythm (rhythm control) while the other uses medication to only control the heart rate in AF (rate control). In clinical trials, neither strategy has been shown to significantly reduce mortality. In patients hospitalized with AF, both strategies are used equally, according to a new study.

Researchers at the Center for Education and Research on Therapeutics at Duke University Medical Center, and colleagues, looked at hospitalization records of patients with a primary diagnosis of AF from approximately 500 hospitals from January 1, 2000, to December 31, 2004. They categorized each hospitalization as using rhythm control or rate control on the basis of in-hospital procedures and medications.

The researchers found that of 155,731 hospitalizations for AF during the study period, 48 percent of the patients received the rhythm control strategy and 52 percent received the rate control strategy. The rate control group included a higher proportion of hospitalizations in which patients had other cardiovascular and pulmonary diseases, but in-hospital ventricular arrhythmias and secondary atrial flutter were significantly less common.

The findings showed no significant difference in the two treatment classes for the use of low-molecular-weight heparin (a blood thinner) or the proportion of patients with rheumatic heart disease. However, there were 56 percent greater odds of warfarin (another type of blood thinner) use in the rhythm control group than in the rate control group, which is not consistent with clinical recommendations. Use of a rate control strategy was three times more likely for patients whose care was managed by a physician who was not a cardiologist and 15 percent more likely for every 5 years of age above 65 years.

The current study was funded in part by a grant from the Agency for Healthcare Research and Quality (HS10548) to the Center for Education and Research on Therapeutics (CERT) at Duke University Medical Center. For more information on the CERT program, please visit http://www.ahrq.gov/clinic/certsovr.htm.

More details are in "Rhythm versus rate control in the contemporary management of atrial fibrillation in-hospital," by Nancy M. Allen LaPointe, Pharm.D., Jie-Lena Sun, M.S., Sigal Kaplan, Ph.D., B.Pharm., and others, in the April 15, 2008, American Journal of Cardiology 101, pp. 1134-1141.

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