Analysis of cause-specific mortality in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study

Analysis of cause-specific mortality in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Steinberg, J. S., Sadaniantz, A., Kron, J., Krahn, A., Denny, D. M., Daubert, J., Campbell, W. B., Havranek, E., Murray, K., Olshansky, B., O'Neill, G., Sami, M., Schmidt, S., Storm, R., Zabalgoitia, M., Miller, J., Chandler, M., Nasco, E. M., & Greene, H. L. j-C, 109(16):1973--1980, 2004.
abstract bibtex

BACKGROUND: Expectations that reestablishing and maintaining sinus rhythm in patients with atrial fibrillation might improve survival were disproved in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. This report describes the cause-specific modes of death in the AFFIRM treatment groups. METHODS AND RESULTS: All deaths in patients enrolled in AFFIRM underwent blinded review by the AFFIRM Events Committee, and a mode of death was assigned. In AFFIRM, 2033 patients were randomized to a rhythm-control strategy and 2027 patients to a rate-control strategy. During a mean follow-up of 3.5 years, there were 356 deaths in the rhythm-control patients and 310 deaths in the rate-control patients (P=0.07). In the rhythm-control group, 129 patients (9%) died of a cardiac cause, and in the rate-control group, 130 patients (10%) died (P=0.95). Both groups had similar rates of arrhythmic and nonarrhythmic cardiac deaths. The numbers of vascular deaths were similar in the 2 groups: 35 (3%) in the rhythm-control group and 37 (3%) in the rate-control group (P=0.82). There were no differences in the rates of ischemic stroke and central nervous system hemorrhage. In the rhythm-control group, there were 169 noncardiovascular deaths (47.5% of the total number of deaths), whereas in the rate-control arm, there were 113 noncardiovascular deaths (36.5% of the total number of deaths) (P=0.0008). Differences in noncardiovascular death rates were due to pulmonary and cancer-related deaths. CONCLUSIONS: Management of atrial fibrillation with a rhythm-control strategy conferred no advantage over a rate-control strategy in cardiac or vascular mortality and may be associated with an increased noncardiovascular death rate.

@Article{RSM:Ste2004,
  author =       "J. S. Steinberg and A. Sadaniantz and J. Kron and A.
                 Krahn and D. M. Denny and J. Daubert and W. B. Campbell
                 and E. Havranek and K. Murray and B. Olshansky and G.
                 O'Neill and M. Sami and S. Schmidt and R. Storm and M.
                 Zabalgoitia and J. Miller and M. Chandler and E. M.
                 Nasco and H. L. Greene",
  title =        "Analysis of cause-specific mortality in the Atrial
                 Fibrillation Follow-up Investigation of Rhythm
                 Management ({AFFIRM}) study",
  journal =      j-C,
  volume =       "109",
  number =       "16",
  pages =        "1973--1980",
  abstract =     "BACKGROUND: Expectations that reestablishing and
                 maintaining sinus rhythm in patients with atrial
                 fibrillation might improve survival were disproved in
                 the Atrial Fibrillation Follow-up Investigation of
                 Rhythm Management (AFFIRM) study. This report describes
                 the cause-specific modes of death in the AFFIRM
                 treatment groups. METHODS AND RESULTS: All deaths in
                 patients enrolled in AFFIRM underwent blinded review by
                 the AFFIRM Events Committee, and a mode of death was
                 assigned. In AFFIRM, 2033 patients were randomized to a
                 rhythm-control strategy and 2027 patients to a
                 rate-control strategy. During a mean follow-up of 3.5
                 years, there were 356 deaths in the rhythm-control
                 patients and 310 deaths in the rate-control patients
                 (P=0.07). In the rhythm-control group, 129 patients
                 (9\%) died of a cardiac cause, and in the rate-control
                 group, 130 patients (10\%) died (P=0.95). Both groups
                 had similar rates of arrhythmic and nonarrhythmic
                 cardiac deaths. The numbers of vascular deaths were
                 similar in the 2 groups: 35 (3\%) in the rhythm-control
                 group and 37 (3\%) in the rate-control group (P=0.82).
                 There were no differences in the rates of ischemic
                 stroke and central nervous system hemorrhage. In the
                 rhythm-control group, there were 169 noncardiovascular
                 deaths (47.5\% of the total number of deaths), whereas
                 in the rate-control arm, there were 113
                 noncardiovascular deaths (36.5\% of the total number of
                 deaths) (P=0.0008). Differences in noncardiovascular
                 death rates were due to pulmonary and cancer-related
                 deaths. CONCLUSIONS: Management of atrial fibrillation
                 with a rhythm-control strategy conferred no advantage
                 over a rate-control strategy in cardiac or vascular
                 mortality and may be associated with an increased
                 noncardiovascular death rate.",
  keywords =     "Aged Anti-Arrhythmia Agents/therapeutic use Atrial
                 Fibrillation/drug therapy/*mortality Follow-Up Studies
                 Humans Proportional Hazards Models Survival Analysis",
  year =         "2004",
}

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