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Heart Rhythm. 2018 Dec;15(12):1825-1832. doi: 10.1016/j.hrthm.2018.06.044. Epub 2018 Jul 3.

Rate control and clinical outcomes in patients with atrial fibrillation and obstructive lung disease.

Author information

1
Department of Biomedical Informatics, Ajou University School of Medicine, Suwon-si, Gyeonggi-do, Korea.
2
Department of Allergy and Clinical Immunology, Ajou University Hospital, Ajou University School of Medicine, Suwon-si, Gyeonggi-do, Korea.
3
Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea.
4
Department of Biomedical Informatics, Ajou University School of Medicine, Suwon-si, Gyeonggi-do, Korea; Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon-si, Gyeonggi-do, Korea.
5
Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea. Electronic address: cby6908@yuhs.ac.

Abstract

BACKGROUND:

Rate-control medications are considered first-line treatment for patients with atrial fibrillation (AF). However, obstructive lung disease (OLD), a condition prevalent in those with AF, often makes it difficult to use those medications because of the lack of studies on new-onset AF in patients with OLD.

OBJECTIVE:

The purpose of this study was to investigate clinical outcomes after administration of each class of rate-control medication in patients with concomitant AF and OLD (AF-OLD).

METHODS:

This study used the entire database provided by the National Health Insurance Service from 2002 to 2015. Risk of all-cause mortality was compared between use of calcium channel blocker (CCB) and use of other drug classes in AF-OLD patients using Cox regression analyses after propensity score matching.

RESULTS:

Among the 13,111 patients, the number of AF-OLD patients treated with a CCB, cardioselective β-blocker (BB), nonselective BB, and digoxin was 2482, 2379, 2255, and 5995, respectively. The risk of mortality was lower with use of selective BB (hazard ratio [HR] 0.84; 95% confidence interval [CI] 0.75-0.94; P = .002) and nonselective BB (HR 0.85; 95% CI 0.77-0.95; P = .003) compared to use of CCBs. Digoxin use was related with worse survival, with marginal statistical significance (HR 1.09; 95% CI 1.00-1.18; P = .053).

CONCLUSION:

Among patients with AF-OLD, rate-control treatment using selective and nonselective BB was associated with a significant reduction in mortality compared with CCB use. Further prospective randomized trials are required to confirm these findings.

KEYWORDS:

Adrenergic beta-antagonist; Atrial fibrillation; Calcium channel blocker; Digoxin; Heart rate; Obstructive lung disease

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