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Acad Emerg Med. 2019 Jan 31. doi: 10.1111/acem.13703. [Epub ahead of print]

Benefits of Rhythm Control and Rate Control in Recent-onset Atrial Fibrillation: The HERMES-AF Study.

Author information

1
Arrhythmia Division, Spanish Society of Emergency Medicine (SEMES), Madrid.
2
Emergency Department, Hospital Universitario Severo Ochoa and Universidad Alfonso X, Madrid.
3
Department, Unitat de Fibril·lació Auricular (UFA), Grup de Recerca "Urgències: processos i patologies", IDIBAPS, Hospital Universitari Clínic, Barcelona.
4
Emergency Department, Hospital de la Axarquía, Málaga.
5
Emergency Department, Hospital Universitario Virgen del Rocío, Sevilla.
6
Emergency Department, Complejo Hospitalario Universitario, Granada.
7
Emergency Department, Hospital de Basurto, Bilbao.
8
Emergency Department, Hospital Donostia, San Sebastián.
9
Emergency Department, Hospital Universitario Río Hortega, Valladolid.
10
Emergency Department, Hospital General Universitario, Alicante.
11
Emergency Department, Hospital Universitario Torrejón, Madrid.
12
Medical Department, Sanofi Spain, Barcelona.
13
Emergency Department, Hospital Universitario La Princesa and Universidad Autónoma, Madrid, Spain.

Abstract

BACKGROUND:

Although rhythm control has failed to demonstrate long-term benefits over rate control in longstanding episodes of atrial fibrillation (AF), there is little evidence concerning recent-onset ones. We analyzed the benefits of rhythm and rate control in terms of symptoms alleviation and need for hospital admission in patients with recent-onset AF.

METHODS:

This was a multicenter, observational, cross-sectional study with prospective standardized data collection carried out in 124 emergency departments (EDs). Clinical variables, treatment effectiveness, and outcomes (control of symptoms, final disposition) were analyzed in stable patients with recent-onset AF consulting for AF-related symptoms.

RESULTS:

Of 421 patients included, rhythm control was chosen in 352 patients (83.6%), a global effectiveness of 84%. Rate control was performed in 69 patients (16.4%) and was achieved in 67 (97%) of them. Control of symptoms was achieved in 396 (94.1%) patients and was associated with a heart rate after treatment ≤ 110 beats/min (odds ratio [OR] = 14.346, 95% confidence interval [CI] = 3.90 to 52.70, p < 0.001) and a rhythm control strategy (OR = 2.78, 95% CI = 1.02 to 7.61, p = 0.046). Sixty patients (14.2%) were admitted: discharge was associated with a rhythm control strategy (OR = 2.22, 95% CI = 1.20-4.60, p = 0.031) and admission was associated with a heart rate > 110 beats/min after treatment (OR = 29.71, 95% CI = 7.19 to 123.07, p < 0.001) and acute heart failure (OR = 9.45, 95% CI = 2.91 to 30.65, p < 0.001).

CONCLUSION:

In our study, recent-onset AF patients in whom rhythm control was attempted in the ED had a high rate of symptoms' alleviation and a reduced rate of hospital admissions.

PMID:
30703274
DOI:
10.1111/acem.13703

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