atrial fibrillation and stroke prevention - Continuing Medical ...
atrial fibrillation and stroke prevention - Continuing Medical ...
atrial fibrillation and stroke prevention - Continuing Medical ...
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
Essentials in Primary Care Conference<br />
Wednesday, July 31, 2013<br />
Questions to answer<br />
• Would this patient benefit more<br />
from rate control or rhythm<br />
control with acute cardioversion<br />
or medical (anti-arrhythmic)<br />
conversion?-AFFIRM, AF-CHF<br />
• What is the target heart rate in a<br />
patient with asx or minimally<br />
symptomatic AF-(lenient vs strict<br />
rate control)?-RACE II<br />
AFFIRM<br />
Atrial Fibrillation Follow-up Investigation<br />
of Rhythm Management<br />
Primary Endpoint: All-Cause Mortality<br />
Mortality (%)<br />
Time (Y)<br />
25<br />
20<br />
15<br />
10<br />
5<br />
0<br />
p = 0.08<br />
•4080 pts,<br />
• mean age 70 yrs<br />
• 40% female<br />
•paroxysmal or persistent <strong>atrial</strong> <strong>fibrillation</strong><br />
•All treated with coumadin<br />
Rhythm<br />
Rate<br />
Rhythm-guideline based anti-arrythmia Rx<br />
Rate-80 at rest,110 with exercise<br />
0 1 2 3 4 5<br />
Rate N 2027 1925 1825 1328 774 236<br />
Rhythm N 2033 1932 1807 1316 780 255<br />
AFFIRM Investigators. N Engl J Med. 2002;347:1825-33<br />
Jan Basile, MD<br />
Atrial Fibrillation & Stroke Prevention
Change language