Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Clinical Trials / Outcomes D-MP13 - Atrial Fibrillation Ablation: What Should I Do Today? (ID 42) Moderated ePoster

D-MP13-01 - Rhythm Control Versus Rate Control In An Ambulatory Atrial Fibrillation Population: A Post-hoc Analysis Of The Integrated Management Program Advancing Community Treatment Of Atrial Fibrillation (IMPACT-AF) Trial (ID 868)

 A. Govindapillai: Nothing relevant to disclose.
Audio File Upload


Background: Symptomatic patients with atrial fibrillation (AF) often require rhtyhm control therapy to improve quality of life. Barriers to access to advanced therapiescan lead to repeated AF-related hospitalizations and emergency department (ED) visits.
Objective: We examined the characteristics and outcomes in a contemporary ambulatory population of AF patients comparing rate and rhythm control.
Methods: This study is a post-hoc analysis of a cluster randomized, trial of 1133 patients with ambulatory AF conducted from 2016-18. IMPACT-AF examined the use of a clinical decision support tool compared to standard care to improve outcomes with AF by general practitioners. This analysis compared patients by type of therapy at baseline: rate vs rhythm control. Outcomes included AF-related ED visits, unplanned cardiovascular hospitalizations and bleeding events at 12 months.
Results: There were 870 patients included in this analysis, 99 (11.4%) were in the rhythm control group, 40% were women. Mean age was younger in the rhythm control group (67 ± 12 vs 73 ± 14, p<0.001), a higher number were paroxysmal (80% vs 43%, p<0.001), and had a lower CHADS2 score. There was a higher rate of AF-related ED visits in the rhythm control group (17.2 vs. 7.3%, p<0.0003), as well as repeat visits (rate ratio 3.03 95% CI (1.99, 4.52, p<0.001). On multivariate analysis, rhythm control remained significantly associated with ED visits (OR 2.17 95%CI (1.18, 4.00), p=0.01)and men were less likely to present to the ED (OR 0.49 95%CI (0.3,0.81),p=0.005). There was no difference in bleeding or cardiovascular events. At 12 months, 33% of patients in rhythm control group had been referred to a specialist, 21% in the rate control group.
Conclusion: Patients on rhythm control therapies comprise approximately one-tenth of this ambulatory AF population but utilize a significantly greater proportion of health care resources, based on our findings. Improved access to advanced rhythm control therapies or alternative models of care for patients with a greater symptom burden could improve outcomes for these patients, as well as improve resource utilization.