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Meta-Analysis
. 2022 Oct 13;20(1):340.
doi: 10.1186/s12916-022-02545-4.

Effectiveness of early rhythm control in improving clinical outcomes in patients with atrial fibrillation: a systematic review and meta-analysis

Wengen Zhu #  1   2   3 , Zexuan Wu #  4   5   6 , Yugang Dong  4   5   6 , Gregory Y H Lip  7   8 , Chen Liu  9   10   11
Affiliations
Meta-Analysis

Effectiveness of early rhythm control in improving clinical outcomes in patients with atrial fibrillation: a systematic review and meta-analysis

Wengen Zhu et al. BMC Med. .

Abstract

Background: Current guidelines recommend rhythm control for improving symptoms and quality of life in symptomatic patients with atrial fibrillation (AF). However, the long-term prognostic outcomes of rhythm control compared with rate control are still inconclusive. In this meta-analysis, we aimed to assess the effects of early rhythm control compared with rate control on clinical outcomes in newly diagnosed AF patients.

Methods: We systematically searched the PubMed and Embase databases up to August 2022 for randomized and observational studies reporting the associations of early rhythm control (defined as within 12 months of AF diagnosis) with effectiveness outcomes. The primary outcome was a composite of death, stroke, admission to hospital for heart failure (HF), or acute coronary syndrome (ACS). Hazard ratios (HRs) and 95% confidence intervals (CIs) from each study were pooled using a random-effects model, complemented with an inverse variance heterogeneity or quality effects model.

Results: A total of 8 studies involving 447,202 AF patients were included, and 23.5% of participants underwent an early rhythm-control therapy. In the pooled analysis using the random-effects model, compared with rate control, the early rhythm-control strategy was significantly associated with reductions in the primary composite outcome (HR = 0.88, 95% CI: 0.86-0.89) and secondary outcomes, including stroke or systemic embolism (HR = 0.78, 95% CI: 0.71-0.85), ischemic stroke (HR = 0.81, 95% CI: 0.69-0.94), cardiovascular death (HR = 0.83, 95% CI: 0.70-0.99), HF hospitalization (HR = 0.90, 95% CI: 0.88-0.92), and ACS (HR = 0.86, 95% CI: 0.76-0.98). Reanalyses using the inverse variance heterogeneity or quality effects model yielded similar results.

Conclusions: Our current meta-analysis suggested that early initiation of rhythm control treatment was associated with improved adverse effectiveness outcomes in patients who had been diagnosed with AF within 1 year.

Registration: The study protocol was registered to PROSPERO (CRD42021295405).

Keywords: Atrial fibrillation; Early rhythm control; Effectiveness; Meta-analysis; Outcomes.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of document retrieval for this meta-analysis
Fig. 2
Fig. 2
Assessment of the association of early rhythm control with primary and secondary outcomes in patients with AF. AF, atrial fibrillation; HF, heart failure; HR, hazard ratio; CI, confidence interval
Fig. 3
Fig. 3
Assessment of the association of early rhythm control with primary and secondary outcomes after excluding the study of Chao et al. AF, atrial fibrillation; HF, heart failure; HR, hazard ratio; CI, confidence interval
Fig. 4
Fig. 4
A summary graph of the pooled results of this meta-analysis. AF, atrial fibrillation; HF, heart failure; SSE, stroke or systemic embolism; ACS=, acute coronary syndrome; HR, hazard ratio; CI, confidence interval
See this image and copyright information in PMC

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