Functional status in rate- versus rhythm-control strategies for atrial fibrillation - Results of the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) functional status substudy
Functional status in rate- versus rhythm-control strategies for atrial fibrillation - Results of the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) functional status substudy
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DOI：
10.1016/j.jacc.2005.07.040
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发表时间：
2005-11-15
影响因子：
24
通讯作者：
Wyse, DG
中科院分区：
文献类型：
--
作者：
Chung, MK;Shemanski, L;Wyse, DG
目的 心房颤动节律管理随访调查 (AFFIRM) 功能状态子研究旨在检验心率控制和节律控制策略中功能状态相似的假设。 背景 包括 AFFIRM 研究在内的随机研究未能证明心房颤动 (AF) 的心率控制和节律控制策略之间的生存益处。然而，房颤可能会导致功能能力或认知障碍，这可能需要维持窦性心律。 方法 AFFIRM 研究的研究人员招募了 4,060 名需要长期治疗、年龄在 65 岁或以上或有其他中风或死亡危险因素的房颤患者。纽约心脏协会功能分级 (NYHA-FC) 和加拿大心血管协会心绞痛分级在初次和每次随访时进行评估。从 22 个随机选择的功能状态子研究地点中，245 名参与者在初次、两个月和每年访视时接受了 6 分钟步行测试和简易精神状态检查 (MMSE)。患者被随机分配使用心率控制药物，使 AF 持续存在，或使用节律控制抗心律失常药物，以维持窦性心律。 结果 在心率控制组和节律控制组中，NYHA-FC 随着时间的推移而恶化，组间没有差异。 AF 的存在与较差的 NTYHA-FC 相关（p < 0.0001）。加拿大心血管协会心绞痛分类或 MMSE 评分没有观察到差异。随着时间的推移，两个研究组的六分钟步行距离都有所改善。平均而言，节奏控制组的步行距离增加了 94 英尺（调整后的 p = 0.049）。结论 节奏控制组的 6 分钟步行距离略有改善。 AF 的存在与 NYHA-FC 恶化相关。没有检测到认知功能的差异。
OBJECTIVES The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) functional status substudy aimed to test the hypothesis that functional status is similar in rate-control and rhythm-control strategies.BACKGROUND Randomized studies, including the AFFIRM study, have failed to demonstrate survival benefits between rate-control and rhythm-control strategies for atrial fibrillation (AF). However, AF may cause functional capacity or cognitive impairment that might justify maintenance of sinus rhythm.METHODS Investigators of the AFFIRM study, enrolled 4,060 patients with AF who required long-term therapy and who were 65 years of age or older or who had another risk factor for stroke or death. New York Heart Association functional class (NYHA-FC) and Canadian Cardiovascular Society Angina Classification were assessed at initial and each follow-up visit. From 22 randomly chosen functional status substudy sites, 245 participants underwent 6-min walk tests and Mini-Mental State Examination (MMSE) at initial, two-month, and Yearly visits. Patients were assigned randomly to rate-controlling drugs, allowing AF to persist, or rhythm-controlling antiarrhythmic drugs, to maintain sinus rhythm.RESULTS The NYHA-FC worsened with time in both rate-control and rhythm-control groups, with no differences between groups. Presence of AF was associated with worse NTYHA-FC (p < 0.0001). No differences were observed in Canadian Cardiovascular Society Angina Classification or MMSE scores. Six-minute walk distance improved over time in both study arms. On average, walk distance was 94 feet greater in the rhythm-control group (adjusted p = 0.049).CONCLUSIONS Modest improvement in 6-min walk distance was noted in the rhythm-control arm. Presence of AF was associated with worse NYHA-FC. No difference in cognitive function was detected.