Rate versus rhythm control for management of atrial fibrillation in clinical practice: results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry.
Rate versus rhythm control for management of atrial fibrillation in clinical practice: results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry.
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DOI：
10.1016/j.ahj.2012.12.019
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发表时间：
2013-04
影响因子：
4.8
通讯作者：
Piccini, Jonathan P.
中科院分区：
文献类型：
--
作者：
Steinberg, Benjamin A.;Holmes, DaJuanicia N.;Ezekowitz, Michael D.;Fonarow, Gregg C.;Kowey, Peter R.;Mahaffey, Kenneth W.;Naccarelli, Gerald;Reiffel, James;Chang, Paul;Peterson, Eric D.;Piccini, Jonathan P.
所有的房颤患者都需要优化他们的心室率。导致在临床实践中使用额外节律控制的因素尚未完全确定。Orbit-AF登记登记了来自广泛实践环境的房颤患者，并根据治疗医生的指示收集了有关心率与节律控制的数据。进行多变量Logistic回归分析以确定与每种策略相关的因素。在纳入的10,061名患者中，6859名(68%)接受了单纯心率控制，而3202名(32%)接受了节律控制。接受心率控制的患者明显年龄较大，更有可能患有高血压、心力衰竭、既往中风和胃肠道出血。他们的房颤相关症状也较少(41%没有任何症状，而节律控制组为31%)。5,448名(79%)心率控制患者使用了全身抗凝药物，而节律控制患者为2,219名(69%)(P<；0.0001)。经多因素调整后，症状评分较高的患者(重度症状与无症状相比，OR为1.62，95%CI为1.41~1.87)和电生理师就诊的患者(OR为1.64，95%CI为1.45~1.85)更有可能采用节律控制策略进行管理。在美国临床实践的这一门诊登记中，大多数房颤患者仅用心率控制进行管理。有更多症状且接受电生理学家治疗的患者更有可能接受节律控制疗法。很大比例的房颤患者，无论采用何种治疗策略，都没有接受抗凝治疗来预防血栓形成。
All patients with atrial fibrillation (AF) require optimization of their ventricular rate. Factors leading to use of additional rhythm control in clinical practice have not been thoroughly defined. The ORBIT-AF registry enrolled patients with AF from a broad range of practice settings and collected data on rate versus rhythm control, as indicated by the treating physician. Multivariable logistic regression analysis was performed to identify factors associated with each strategy. Of 10,061 patients enrolled, 6,859 (68%) were managed with rate only control versus 3,202 (32%) with rhythm control. Patients managed with rate control were significantly older and more likely to have hypertension, heart failure, prior stroke, and gastrointestinal bleeds. They also had fewer AF-related symptoms (41% with no symptoms vs 31% for rhythm control). Systemic anticoagulation was prescribed for 5,448 (79%) rate-control patients versus 2,219 (69%) rhythm-control patients (P < .0001). After multivariable adjustment, patients with higher symptom scores (severe symptoms vs. none, OR 1.62, 95% CI 1.41–1.87) and those referred to electrophysiologists (OR 1.64, 95% CI 1.45–1.85) were more likely to be managed with a rhythm control strategy. In this outpatient registry of US clinical practice, the majority of patients with AF were managed with rate control alone. Patients with more symptoms and who were treated by an electrophysiologist were more likely to receive rhythm-control therapies. A significant proportion of AF patients, regardless of treatment strategy, were not treated with anticoagulation for thromboembolism prophylaxis.
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影响因子：
2.8
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Reiffel, James A.;Kowey, Peter R.;Waldo, Albert L.
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Crijns, Harry J. G. M.