Relationships between sinus rhythm, treatment, and survival in the atrial fibrillation follow-up investigation of rhythm management (AFFIRM) study
Relationships between sinus rhythm, treatment, and survival in the atrial fibrillation follow-up investigation of rhythm management (AFFIRM) study
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DOI：
10.1161/01.cir.0000121736.16643.11
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发表时间：
2004-03-30
期刊：
影响因子：
37.8
通讯作者：
Wyse, DG
中科院分区：
文献类型：
--
作者：
Corley, SD;Epstein, AE;Wyse, DG
AFFIRM研究表明，在意向治疗分析中，节律控制策略治疗房颤和卒中或死亡高风险患者与心率控制策略相比，没有生存优势。本文报道了一个“治疗”分析的关系，生存率的心脏节律和治疗，因为他们改变了随着时间的推移。方法和结果-建模技术被用来确定生存，基线临床变量和时间依赖性变量之间的关系。以下基线变量与死亡风险增加显著相关：年龄增加、冠状动脉疾病、充血性心力衰竭、糖尿病、卒中或短暂性脑缺血发作、吸烟、左心室功能障碍和二尖瓣返流。在时间依赖性变量中，窦性心律（SR）的存在与较低的死亡风险相关，华法林的使用也是如此。抗心律失常药物（AAD）与死亡率增加，只有调整后的SR的存在。与原来的意向治疗分析一致，AAD不再与死亡率时，SR从model.Conclusions -Warrantine使用改善生存。SR是生存的重要决定因素，或者是与生存相关的其他因素的标志物，这些因素未被记录、确定或包括在生存模型中。目前可用的AAD与生存率改善无关，这表明AAD的任何有益的抗肿瘤作用都被其不良反应所抵消。如果有一种有效的方法来维持SR，减少不良反应，这可能是有益的。
Background - The AFFIRM Study showed that treatment of patients with atrial fibrillation and a high risk for stroke or death with a rhythm-control strategy offered no survival advantage over a rate-control strategy in an intention-to-treat analysis. This article reports an "on-treatment" analysis of the relationship of survival to cardiac rhythm and treatment as they changed over time.Methods and Results - Modeling techniques were used to determine the relationships among survival, baseline clinical variables, and time-dependent variables. The following baseline variables were significantly associated with an increased risk of death: increasing age, coronary artery disease, congestive heart failure, diabetes, stroke or transient ischemic attack, smoking, left ventricular dysfunction, and mitral regurgitation. Among the time-dependent variables, the presence of sinus rhythm (SR) was associated with a lower risk of death, as was warfarin use. Antiarrhythmic drugs (AADs) were associated with increased mortality only after adjustment for the presence of SR. Consistent with the original intention-to-treat analysis, AADs were no longer associated with mortality when SR was removed from the model.Conclusions - Warfarin use improves survival. SR is either an important determinant of survival or a marker for other factors associated with survival that were not recorded, determined, or included in the survival model. Currently available AADs are not associated with improved survival, which suggests that any beneficial antiarrhythmic effects of AADs are offset by their adverse effects. If an effective method for maintaining SR with fewer adverse effects were available, it might be beneficial.