Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 May 21;40(4):822-829.
doi: 10.1002/joa3.13059. eCollection 2024 Aug.

One-year outcomes of rate versus rhythm control of atrial fibrillation in the Kerala-AF Registry

Peter Calvert  1 , Yang Chen  1 , Ying Gue  1 , Dhiraj Gupta  1 , Jinbert Lordson Azariah  2   3 , A George Koshy  4 , Geevar Zachariah  5 , Gregory Y H Lip  1   6 , Bahuleyan Charantharayil Gopalan  7 ; Kerala AF Registry Investigators
Collaborators, Affiliations

One-year outcomes of rate versus rhythm control of atrial fibrillation in the Kerala-AF Registry

Peter Calvert et al. J Arrhythm. .

Abstract

Background: There is ongoing debate around rate versus rhythm control strategies for managing atrial fibrillation (AF), however, much of the data comes from Western cohorts. Kerala-AF represents the largest prospective AF cohort study from the Indian subcontinent.

Objectives: To compare 12-month outcomes between rate and rhythm control strategies.

Methods: Patients aged ≥18 years with non-transient AF were recruited from 53 hospitals across Kerala. Patients were stratified by rate or rhythm control. The primary outcome was a composite of all-cause mortality, arterial thromboembolism, acute coronary syndrome or hospitalization due to heart failure or arrhythmia at 12 months. Secondary outcomes included bleeding events and individual components of the primary. Predictors of the composite outcome were analysed by logistic regression.

Results: A total of 2901 patients (mean age 64.6 years, 51% female) were included (2464 rate control, 437 rhythm control). Rates of the primary composite outcome did not differ between groups (29.7% vs 30.0%; p = .955), nor did any component of the primary. Bleeding outcomes were also similar (1.6% vs 1.9%; p = .848). Independent predictors of the primary composite outcome were older age (aOR 1.01; p = .013), BMI <18 (aOR 1.51; p = .025), permanent AF (aOR 0.78; p = .010), HFpEF (aOR 1.40; p = .023), HFrEF (aOR 1.39; p = .004), chronic kidney disease (aOR 1.36; p < .001), and prior thromboembolism (aOR 1.31; p = .014).

Conclusion: In the Kerala-AF registry, 12-month outcomes did not differ between rate and rhythm control cohorts.

Keywords: South Asia; atrial fibrillation; rate control; rhythm control.

PubMed Disclaimer

Conflict of interest statement

GYHL reports: Consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, Daiichi‐Sankyo, Anthos. No fees are received personally. GYHL is a National Institute for Health and Care Research (NIHR) Senior Investigator and co‐principal investigator of the AFFIRMO project on multimorbidity in AF, which has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 899871. DG reports: Speaker for Boehringer Ingelheim, Biosense Webster and Boston Scientific. Proctor for Abbott. Research Grants from Medtronic, Biosense Webster, and Boston Scientific. The other authors report no conflicts of interest.

References

    1. Soman CR, Kutty VR, Safraj S, Vijayakumar K, Rajamohanan K, Ajayan K. All‐cause mortality and cardiovascular mortality in Kerala state of India. Asia Pac J Public Health. 2011;23(6):896–903. - PubMed
    1. Thankappan KR, Shah B, Mathur P, Sarma PS, Srinivas G, Mini GK, et al. Risk factor profile for chronic non‐communicable diseases: results of a community‐based study in Kerala, India. Indian J Med Res. 2010;131:53–63. - PubMed
    1. Charantharayil Gopalan B, Namboodiri N, Abdullakutty J, Lip GY, Koshy AG, Krishnan Nair V, et al. Kerala Atrial Fibrillation Registry: a prospective observational study on clinical characteristics, treatment pattern and outcome of atrial fibrillation in Kerala, India, cohort profile. BMJ Open. 2019;9(7):e025901. - PMC - PubMed
    1. Lip GYH. The ABC pathway: an integrated approach to improve AF management. Nat Rev Cardiol. 2017;14(11):627–628. Available from: http://www.nature.com/articles/nrcardio.2017.153 - PubMed
    1. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström‐Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio‐Thoracic Surgery (EACTS): the Task Force for the diagnosis and management of atrial fibrillation of the Europe. Eur Heart J. 2021;42(5):373–498. Available from: https://academic.oup.com/eurheartj/article‐pdf/42/5/373/36414945/ehaa612... - PubMed

LinkOut - more resources