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Clinical characteristics and cardiovascular outcomes in patients with atrial fibrillation receiving rhythm-control therapy: the Fushimi AF Registry

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A Correction to this article was published on 27 June 2018

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Abstract

Management of atrial fibrillation (AF) with current rhythm-control therapy has an uncertain impact on outcomes. Among 3731 patients in the Fushimi AF Registry, a community-based prospective survey of AF patients in Fushimi-ku, Kyoto, we investigated the characteristics and outcomes in 478 patients receiving rhythm-control therapy (anti-arrhythmic drug and/or catheter ablation) alone, with 1279 patients receiving rate-control therapy (beta-blockers, calcium channel blockers, and digoxin) alone serving as a reference. The Rhythm-control group, 26% of which had prior catheter ablation, was younger (70.5 ± 10.8 vs. 74.3 ± 10.4 years, P < 0.001) with lower CHA2DS2-VASc score (2.71 ± 1.63 vs. 3.64 ± 1.62, P < 0.001) and received oral anticoagulants less frequently than the Rate-control group. During the median follow-up of 1107 days, the incidence of the composite of cardiac death and heart failure (HF) hospitalization was lower with rhythm control (hazard ratio (HR) 0.24, 95% confidence interval (CI) 0.14–0.36; P < 0.001), whereas that of ischemic stroke/systemic embolism was not significantly different (HR 0.64, 95% CI 0.35–1.10; P = 0.12), when compared to rate control. Propensity score-matching analysis as well as multivariate analysis further supported the relation of Rhythm-control group to the lower incidence of the composite of cardiac death and HF hospitalization. Rhythm-control therapy by anti-arrhythmic drug and/or catheter ablation in the contemporary clinical practice was associated with the lower incidence of the composite of cardiac death and HF hospitalization, as compared with rate-control therapy in a Japanese AF cohort. However, given the fundamental differences in baseline clinical characteristics between the rhythm- and Rate-control groups, the results cannot be generalizable.

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  • 27 June 2018

    In the original publication of the article, the data of Body mass index ≥ 25 (kg/m2)a is published incorrectly in Table 1. Since this is categorical variable, the data should have been expressed as a number (percentage), not as mean ± standard deviation. The corrected version of Table 1 is as below,

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Acknowledgements

M. Akao had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. We sincerely appreciate the efforts of the clinical research coordinators (T. Shinagawa, M. Mitamura, M. Fukahori, M. Kimura, M. Fukuyama, and C. Kamata).

The following is a list of the institutions participating in the registry.

Chief investigator: Akao M (National Hospital Organization Kyoto Medical Center).

Vice-chief investigator: Esato M (Ijinkai Takeda General Hospital).

Steering committee: Abe M (National Hospital Organization Kyoto Medical Center), Tsuji H (Tsuji Clinic), and Furuke K (Furuke Clinic).

Statistical analysis: Wada H (National Hospital Organization Kyoto Medical Center).

Coordinator: Ogawa T (Ogawa Medical Office), Tasato H (Tasato Clinic), Taniguchi Y (Taniguchi Clinic), Nishikawa M (Nishikawa Clinic), Furukawa K (Furukawa Medical Clinic), Kawai C, Hashimoto T, Kanda M (Ijinkai Takeda General Hospital), Tsukahara T, Fukuda S, Nakamura M, Ohtani R, Ito T, and Hasegawa K (National Hospital Organization Kyoto Medical Center).

Clinical event committee: Kawabata Y, Yasuda K, and Kameyama K (National Hospital Organization Kyoto Medical Center).

Participating institutions: Department of Cardiology, National Hospital Organization Kyoto Medical Center (Akao M, Abe M, Ogawa H, Masunaga N, Iguchi M, Ishii M, An Y, Unoki T, Niki S, Takabayashi K, Hamatani Y, Yamashita Y, Takagi D, Tezuka Y, Doi K, Aono Y, Ikeda S, Osakada G, Nakashima Y, Kanasaki M, Nakano T, Funatsu J, Nishio M, and Takenaka Y); Department of Arrhythmia, Ijinkai Takeda General Hospital (Chun YH, Esato M, Kida Y, Nishina N); Koujinkai Oshima Hospital (Terada K); Division of Translational Research, National Hospital Organization Kyoto Medical Center (Hasegawa K, Wada H); Kanai Hospital (Nishio M, Kamiya Y, Abe M, Ishii M); Tsuji clinic (Tsuji H); Furukawa Medical Clinic (Furukawa K); Nishikawa Clinic (Nishikawa M); Taniguchi Clinic (Taniguchi Y); Gushiken Clinic (Gushiken T); Kyoto Rehabilitation Hospital (Hirata Y); Yoda Clinic (Yoda J); Tasato Clinic (Tasato H); Ogawa Medical Office (Ogawa T); Mukaijima Hospital (Wakatsuki Y, Yahata M, Higashitani N); Itoh Hemodialysis Clinic (Itoh H); Itoh Clinic (Itoh H, Ohmori Y); Ryokuhoukai Tsuji Clinic (Tsuji K); Kitamura Clinic (Kitamura S); Izumikawa Clinic (Izumikawa F); Hirota Clinic (Hirota N); Kyomachi-Oota Clinic (Oota K); Kouseikai Rehabilitation Clinic (Kou K); Inariyama Takeda Hospital (Tanaka T, Iguchi M); Matsushita Clinic (Matsushita N); Kitani Clinic (Kitani K); Kimura Clinic (Kimura F); Hayashi Clinic (Hayashi S); Handa Clinic (Handa S); Soseikai General Hospital (Hasegawa S, Kono T, Otsuka K, Soyama A, Okamoto J, Nakai Y); Asamoto Clinic (Asamoto H); Sugano Clinic (Tanaka H, Murata T); Fushimi Momoyama General Hospital (Kayawake S, Kinoshita Y); Furuke Clinic (Furuke K); Kanehisa Clinic (Asano N); Tahara Clinic (Tahara K); Matsumoto Medical Office (Matsumoto K); Kuroda Clinic (Kuroda O); Ochiai Clinic (Ochiai K, Ochiai J); Fujii Clinic (Fujii M); Kurihara Clinic (Kurihara M); Kuzuyama Clinic (Ito A); Kenkokai Fushimi Clinic (Totsuzaki S); Nakayama Orthopedic Clinic (Nakayama H); Department of Cardiovascular Medicine, Ijinkai Takeda General Hospital (Kawai C, Hashimoto T, Kakio T, Watanabe C, Takeda S, Sasaki Y, Shirasawa K, Beppu K, Inoue T, Shirasaka A, Doi T); Tatsumi Clinic (Ueda T); Oishi Clinic (Oishi M); Koizumi Clinic (Kasahara A); Kishida Clinic (Kishida Su, Kishida Sa); Shibata Clinic (Shibata M); Shimizu Clinic (Shimizu J); Shirasu Clinic (Shirasu M); Fujinokai Clinic (Tateishi S); Tsukuda Clinic (Tsukuda N); Shinseikai Tsuji Clinic (Tsuji K); Nishi Clinic (Nishi T); Nishimura Clinic (Nishimura S); Haba Clinic (Haba T); Higashimae Clinic (Higashimae R); Fujimori Clinic (Fujimori C); Hotta Clinic (Hotta T); Matsui Clinic (Matsui H, Matsui H); Shadan Matsumoto Clinic (Matsumoto H); Maruo Clinic (Maruo N); Misu Clinic (Mikami M); Mekata Clinic (Mekata H); Mori Pediatric Clinic (Mori H); Wakabayashi Clinic (Wakabayashi M); Nakatsugawa Clinic (Sasaki Z); Shiseikai Nishimura Clinic (Nishimura S); Yuge Eye Clinic (Yuge K); Gokita Hospital (Haruta M); Soseikai Clinic (Tsuda E); Toujinkai Hospital (Nishimura M); Kouno Clinic (Kouno T, Kouno Y); Matsumura Clinic (Matsumura S); Fujita Clinic (Fujita A); Takayasu Clinic (Takayasu F, Takayasu S); Yano Clinic (Yano Y), Niki Clinic (Niki S); Hasegawa Meiando Clinic (Hasegawa S); Watanabe Medical Clinic (Watanabe T).

Funding

The Fushimi AF Registry is supported by research funding from Boehringer Ingelheim, Bayer Healthcare, Pfizer, Bristol-Myers Squibb, Astellas Pharma, AstraZeneca, Daiichi Sankyo, Novartis Pharma, MSD, Sanofi-Aventis and Takeda Pharmaceutical. The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. This research is partially supported by the Practical Research Project for Lifestyle-related Diseases including Cardiovascular Diseases and Diabetes Mellitus from Japan Agency for Medical Research and Development, AMED (18ek0210082h0002, 18ek0210056h0003).

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    Authors and Affiliations

    1. Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555, Japan

      Yoshimori An, Mitsuru Ishii, Moritake Iguchi, Nobutoyo Masunaga, Hisashi Ogawa, Mitsuru Abe & Masaharu Akao

    2. Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan

      Masahiro Esato

    3. Tsuji Clinic, Kyoto, Japan

      Hikari Tsuji

    4. Division of Translational Research, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

      Hiromichi Wada & Koji Hasegawa

    5. Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK

      Gregory Y. H. Lip

    6. Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

      Gregory Y. H. Lip

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    1. Yoshimori An
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    Contributions

    YA analyzed the data and wrote the paper. YH and GL helped data analysis and interpretation. ME, YC, MI, MI, NM, HT, HW, KH, HO and M. Abe are executive members of the organizing committee of the Fushimi AF Registry. M. Akao is a principal investigator of the Fushimi AF Registry, and the corresponding author of this paper.

    Corresponding author

    Correspondence to Masaharu Akao.

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    Conflict of interest

    Dr. Akao received lecture fees from Pfizer, Bristol-Myers Squibb, Boehringer Ingelheim, Bayer Healthcare and Daiichi Sankyo. Dr Lip has served as a consultant for Bayer, Merck, Sanofi, BMS/Pfizer, Daiichi Sankyo, Biotronik, Medtronic, Portola and Boehringer Ingelheim and has been on the speakers bureau for Bayer, BMS/Pfizer, Boehringer Ingelheim, Daiichi Sankyo, Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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    Gregory Y. H. Lip and Masaharu Akao are joint senior authors.

    Electronic supplementary material

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    380_2018_1194_MOESM1_ESM.jpg

    Supplementary material 1 (JPEG 273 kb) Figure S1 Unadjusted Kaplan–Meier curves for the incidence of cardiac death/HF hospitalization between those with and without previous catheter ablation among the Rhythm-control group. CA = catheter ablation

    380_2018_1194_MOESM2_ESM.jpg

    Supplementary material 2 (JPEG 440 kb) Figure S2 Unadjusted hazard ratio for cardiac death/HF hospitalization, according to major subgroups. Forest plots show hazard ratio with error bars indicating 95% confidence interval. BMI = body mass index. Anemia was defined as the hemoglobin level < 11 g/dl. Renal dysfunction was defined as the estimated glomerular filtration rate < 60 ml/min/m2

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    An, Y., Esato, M., Ishii, M. et al. Clinical characteristics and cardiovascular outcomes in patients with atrial fibrillation receiving rhythm-control therapy: the Fushimi AF Registry. Heart Vessels 33, 1534–1546 (2018). https://doi.org/10.1007/s00380-018-1194-5

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