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Analysis of cause-specific mortality in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study.
Circulation. 2004 Apr 27;109(16):1973-80
Publication Type
Jonathan S Steinberg
Ara Sadaniantz
Jack Kron
Andrew Krahn
D Marty Denny
James Daubert
W Barton Campbell
Edward Havranek
Katherine Murray
Brian Olshansky
Gearoid O'Neill
Magdi Sami
Stanley Schmidt
Randle Storm
Miguel Zabalgoitia
John Miller
Mary Chandler
Elaine M Nasco
H Leon Greene
Author Affiliation
Division of Cardiology, St Luke's-Roosevelt Hospital Center and Columbia University, New York, NY 10025, USA.
Circulation. 2004 Apr 27;109(16):1973-80
Publication Type
Anti-Arrhythmia Agents - therapeutic use
Atrial Fibrillation - drug therapy - mortality
Follow-Up Studies
Proportional Hazards Models
Research Support, U.S. Gov't, P.H.S.
Survival Analysis
BACKGROUND: Expectations that reestablishing and maintaining sinus rhythm in patients with atrial fibrillation might improve survival were disproved in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. This report describes the cause-specific modes of death in the AFFIRM treatment groups. METHODS AND RESULTS: All deaths in patients enrolled in AFFIRM underwent blinded review by the AFFIRM Events Committee, and a mode of death was assigned. In AFFIRM, 2033 patients were randomized to a rhythm-control strategy and 2027 patients to a rate-control strategy. During a mean follow-up of 3.5 years, there were 356 deaths in the rhythm-control patients and 310 deaths in the rate-control patients (P=0.07). In the rhythm-control group, 129 patients (9%) died of a cardiac cause, and in the rate-control group, 130 patients (10%) died (P=0.95). Both groups had similar rates of arrhythmic and nonarrhythmic cardiac deaths. The numbers of vascular deaths were similar in the 2 groups: 35 (3%) in the rhythm-control group and 37 (3%) in the rate-control group (P=0.82). There were no differences in the rates of ischemic stroke and central nervous system hemorrhage. In the rhythm-control group, there were 169 noncardiovascular deaths (47.5% of the total number of deaths), whereas in the rate-control arm, there were 113 noncardiovascular deaths (36.5% of the total number of deaths) (P=0.0008). Differences in noncardiovascular death rates were due to pulmonary and cancer-related deaths. CONCLUSIONS: Management of atrial fibrillation with a rhythm-control strategy conferred no advantage over a rate-control strategy in cardiac or vascular mortality and may be associated with an increased noncardiovascular death rate.
Comment In: Circulation. 2004 Sep 14;110(11):e307-8; author reply e307-815364827
PubMed ID
15051639 View in PubMed
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