ACC: Lenient Rate Control Studied in Atrial Fibrillation

Approach may be as effective as strict rate control in preventing adverse cardiovascular outcomes
By Beth Gilbert
HealthDay Reporter

MONDAY, March 15 (HealthDay News) -- While current guidelines recommend strict rate control in patients with permanent atrial fibrillation, lenient rate control is just as effective in preventing cardiovascular morbidity and mortality, according to a study published online March 15 in the New England Journal of Medicine to coincide with the Annual Scientific Session of the American College of Cardiology, held from March 14 to 16 in Atlanta.

Isabelle C. Van Gelder, M.D., of the University of Groningen in the Netherlands, and colleagues randomized 614 individuals with permanent atrial fibrillation to lenient rate control (resting heart rate of fewer than 110 beats per minute) or strict rate control (resting heart rate of fewer than 80 beats per minute and fewer than 110 beats per minute during moderate exercise).

At three years, the researchers estimated that the cumulative incidence of the primary end point (composite of death from cardiovascular causes, systemic embolism, bleeding, life-threatening arrhythmic events, and hospitalization for heart failure and stroke) was 12.9 percent for the lenient rate-control group and 14.9 percent for the strict rate-control group. The frequencies of the components of the primary end point were similar for both groups. In addition, rates of symptoms and adverse events were similar for both groups. However, more patients met the heart-rate targets in the lenient rate-control group than in the strict rate-control group (97.7 versus 67 percent), with fewer outpatient visits.

"In conclusion, as compared with strict rate control, lenient rate control was non-inferior in terms of major clinical events. Furthermore, for both patients and healthcare providers, lenient rate control is more convenient, since fewer outpatient visits and examinations are needed," the authors write.

The study was supported in part by AstraZeneca, Biotronik, Boehringer Ingelheim, Boston Scientific, Medtronic, Roche and Sanofi Aventis France. Several authors reported financial relationships with these companies.

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