The atrial fibrillation follow-up investigation of rhythm management (AFFIRM) study - Approaches to control rate in atrial fibrillation
The atrial fibrillation follow-up investigation of rhythm management (AFFIRM) study - Approaches to control rate in atrial fibrillation
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DOI：
10.1016/j.jacc.2003.11.032
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发表时间：
2004-04-07
影响因子：
24
通讯作者：
Greene, HL
中科院分区：
文献类型：
--
作者：
Olshansky, B;Rosenfeld, LE;Greene, HL
目的：我们试图评估心房颤动节律管理随访调查（AFFIRM）研究中用于控制率的方法、控制率的有效性以及从一种药物类别切换到另一种药物类别。AFFIRM研究表明，控制心率和抗凝治疗房颤（AF）是有效的，但药物对控制率的疗效尚不确定。方法：在AFFIRM研究中，患者（n = 2027）随机分为率控制组，由主治医师给予率控制药物。事先制定的标准化率控制疗效标准包括静息心率和6分钟步行测试和/或动态心电图结果。结果平均随访时间为3.5±1.3年。初始治疗包括24%的患者单独使用β -肾上腺素受体阻滞剂（β -受体阻滞剂），17%的患者单独使用钙通道阻滞剂，16%的患者单独使用地高辛，14%的患者同时使用β -受体阻滞剂和地高辛，14%的患者同时使用钙通道阻滞剂和地高辛。70%的患者首次使用受体阻滞剂（联合或不联合地高辛），54%的患者使用钙通道阻滞剂（联合或不联合地高辛），58%的患者单独使用地高辛。在首次用药或联合用药的患者中，58%的患者达到了适当的总体发生率控制。多变量分析显示首药类别与多个临床变量之间存在关联。受体阻滞剂的变化大于其他两类药物（p < 0.0001）。结论：大多数AF患者可以控制房颤的发生率，β受体阻滞剂是最有效的药物。为了达到充分控制所有患者的目标，需要频繁更换药物和联合用药。(C) 2004年由美国心脏病学会基金会发布。
OBJECTIVES We sought to evaluate approaches used to control rate, the effectiveness of rate control, and switches from one drug class to another in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study.BACKGROUND The AFFIRM study showed that atrial fibrillation (AF) can be treated effectively with rate control and anticoagulation, but drug efficacy to control rate remains uncertain.METHODS Patients (n = 2,027) randomized to rate control in the AFFIRM study were given rate-controlling drugs by their treating physicians. Standardized rate-control efficacy criteria developed a priori included resting heart rate and 6-min walk tests and/or ambulatory electrocardiographic results.RESULTS Average follow-up was 3.5 +/- 1.3 years. Initial treatment included a beta-adrenergic blocker (beta-blocker) alone in 24%, a calcium channel blocker alone in 17%, digoxin alone in 16%, a beta-blocker and digoxin in 14%, or a calcium channel blocker and digoxin in 14% of patients. Overall rate control was achieved in 70% of patients given beta-blockers as the first drug (with or without digoxin), 54% with calcium channel blockers (with or without digoxin), and 58% with digoxin alone. Adequate overall rate control was achieved in 58% of patients with the first drug or combination. Multivariate analysis revealed an association between first drug class and several clinical variables. There were more changes to beta-blockers than to the other two-drug classes (p < 0.0001).CONCLUSIONS Rate control in AF is possible in the majority of patients with AF. Beta-blockers were the most effective drugs. To achieve the goal of adequate rate control in all patients, frequent medication changes and drug combinations were needed. (C) 2004 by the American College of Cardiology Foundation.