atrial fibrillation and stroke prevention - Continuing Medical ...
atrial fibrillation and stroke prevention - Continuing Medical ...
atrial fibrillation and stroke prevention - Continuing Medical ...
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Essentials in Primary Care Conference<br />
Wednesday, July 31, 2013<br />
The Atrial Fibrillation <strong>and</strong> Congestive Heart Failure<br />
(AF-CHF) [EF < 35%, clinical HF] Trial: Results<br />
(n=1376;1 endpoint=time to death from CV causes<br />
Rhythm Control<br />
Rate<br />
Control<br />
p-value<br />
Cardiovascular<br />
Mortality<br />
26.7 % 25.2 % NS<br />
Total Mortality 31.8 % 32.9 % NS<br />
Stroke 2.6 % 3.6 % NS<br />
Hospitalization 46 % 39 % 0.001<br />
Worsening CHF 27.6 % 30.8 % NS<br />
Roy et al. N Engl J Med. 2008;358:2667-2677.<br />
RAte Control Efficacy in Permanent<br />
Atrial Fibrillation II (RACE II)<br />
• Since rate control is as good as rhythm<br />
control, then let’s test 311 patients<br />
r<strong>and</strong>omized to lenient (resting HR < 110<br />
BPM) vs 303 strict rate control (resting HR<br />
< 80 BPM, with exercise < 110 BPM)<br />
• Mean follow-up 2 years, max 3 years<br />
• BB alone (45%), CCB alone (6%), digoxin<br />
alone (6%), BB + dig (17%), BB +<br />
dilt/verap (3%), sotalol (5%), amiod (1.3%)<br />
Van Gelder IC, et al. RACE II trial. NEJM 2010;362:1363-73.<br />
Jan Basile, MD<br />
Atrial Fibrillation & Stroke Prevention
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