Generalizability of Trial Findings Supporting Early Rhythm Control in Atrial Fibrillation

Following results from the EAST-AFNET4 trial, which demonstrated clinical benefits of early rhythm control in patients with atrial fibrillation, researchers, led by Shinwan Kany, applied the trial’s inclusion/exclusion criteria to the UK Biobank to assess the generalizability of the trial’s findings. According to their study, published in Heart, approximately 80% of patients with atrial fibrillation in the UK population were eligible for early therapy.

The authors also concluded that early rhythm control therapy via antiarrhythmic drug therapy or atrial fibrillation ablation was safe during the routine care of patients with atrial fibrillation.

The researchers identified 35,562 patients with atrial fibrillation out of 502,493 (7.1%) participants in the UK Biobank, of which 8,340 had atrial fibrillation at enrollment and 27,186 developed incident atrial fibrillation during follow-up. Hospital Episode Statistics data were compared to UK Biobank data to evaluate early rhythm control impact, and safety and efficacy was compared between the cohort and a propensity-matched group.

Viability of Early Rhythm Control in Atrial Fibrillation

The authors found that 22,003 of 27,186 (80.9%) patients with incident atrial fibrillation were eligible for early rhythm control based on the EAST-AFNET4 enrollment criteria. Additionally, eligible patients were on average older (70 vs. 63 years) and more likely to be female (42% vs. 21%) compared to ineligible individuals.

Among 9,004 patients with full primary care records available, 874 (9.02%) had received early rhythm control therapy. These patients showed no additional safety signals compared to controls. Furthermore, patients who received early rhythm control had a lower incidence of the primary composite outcome of EAST-AFNET4 (cardiovascular death, stroke/transient ischemic attack, and hospitalization for heart failure or acute coronary syndrome) compared to controls in the full cohort (hazard ratio [HR] 0.82; 95% confidence interval [CI], 0.71-0.94; P=.005). Finally, early therapy did not significantly decrease the primary outcome compared to usual care in propensity matched comparisons (HR 0.87; 95% CI, 0.72-1.04; P=.124), which the authors suggested was “likely due to smaller absolute effect estimator and low power.”

Ultimately, Kany and colleagues stated that “early rhythm control should become a routine part of the clinical management of most patients with recently diagnosed AF.”

Find more recent studies on the Atrial Fibrillation Knowledge Hub