Targeted therapy of underlying conditions improves sinus rhythm maintenance in patients with persistent atrial fibrillation: results of the RACE 3 trial
Open accessAbstract
Aims: Atrial fibrillation (AF) is a progressive disease. Targeted therapy of underlying conditions refers to interventions aiming to modify risk factors in order to prevent AF. We hypothesised that targeted therapy of underlying conditions improves sinus rhythm maintenance in patients with persistent AF. Methods and results: We randomized patients with early persistent AF and mild-to-moderate heart failure (HF) to targeted therapy of underlying conditions or conventional therapy. Both groups received causal treatment of AF and HF, and rhythm control therapy. In the intervention group, on top of that, four therapies were started: (i) mineralocorticoid receptor antagonists (MRAs), (ii) statins, (iii) angiotensin converting enzyme inhibitors and/or receptor blockers, and (iv) cardiac rehabilitation including physical activity, dietary restrictions, and counselling. The primary endpoint was sinus rhythm at 1 year during 7 days of Holter monitoring. Of 245 patients, 119 were randomized to targeted and 126 to conventional therapy. The intervention led to a contrast in MRA (101 [85%] vs. 5 [4%] patients, P < 0.001) and statin use (111 [93%] vs. 61 [48%], P < 0.001). Angiotensin converting enzyme inhibitors/angiotensin receptor blockers were not different. Cardiac rehabilitation was completed in 109 (92%) patients. Underlying conditions were more successfully treated in the intervention group. At 1 year, sinus rhythm was present in 89 (75%) patients in the intervention vs. 79 (63%) in the conventional group (odds ratio 1.765, lower limit of 95% confidence interval 1.021, P = 0.042). Conclusions: RACE 3 confirms that targeted therapy of underlying conditions improves sinus rhythm maintenance in patients with persistent AF. Trial Registration number: Clinicaltrials.gov NCT00877643.
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In the RACE 3 trial, 119 individuals with persistent AF and HF performed moderate intensity cardiac rehabilitation while 126 controls received usual care, and sinus rhythm was present in 75% of patients who performed cardiac rehabilitation versus 63% in patients who received usual care after 1 year of follow-up.
“In another equally significant study, the RACE 3 trial, 119 individuals with persistent AF and HF performed moderate intensity cardiac rehabilitation while 126 controls with the same background received the usual care. The trial showed that a sinus rhythm was present in 75% of patients who performed cardiac rehabilitation versus 63% in patients who received usual care after 1 year of follow-up [73”
From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [73]
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“The trial showed that a sinus rhythm was present in 75% of patients cardiac rehabilitation versus 63% in patients who received usual care after follow-up [73].”
Background
- Authors
- Rienstra, M., Hobbelt, A. H., Alings, M., Tijssen, J. G. P., Smit, M. D., Brügemann, J., Geelhoed, B., Tieleman, R. G., Hillege, H. L., Tukkie, R., Van Veldhuisen, D. J., Crijns, H. J. G. M., Van Gelder, I. C., & for the RACE 3 Investigators
- Affiliations
- University Medical Center Groningen (NL)
- Amphia Ziekenhuis (NL)
- Amsterdam UMC Location University of Amsterdam (NL)
- Martini Ziekenhuis (NL)
- Spaarne Ziekenhuis (NL)
- Department of Cardiology, University of Groningen University Medical Centre Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
- Maastricht University Medical Centre (NL)
- ORCID
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-02-01
- Volume
- 39
- Issue
- 32
- Pages
- 2987-2996
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2789203914
- Cited by
- 313
- References
- 9
- Citations by year
- 2026: 20 · 2025: 31 · 2024: 41 · 2023: 29 · 2022: 39 · 2021: 56 · 2020: 49 · 2019: 26 · 2018: 22
- FWCI
- 20.77
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Funders
- Netherlands Heart Foundation (2008B035)
- Netherlands Heart Institute; Unrestricted
- AstraZeneca
- Bayer
- Biotronik
- Boehringer-Ingelheim
- Boston Scientific
- Medtronic
- Sanofi-Aventis
- St Jude Medical
- Netherlands Heart Institute
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- persistent atrial fibrillation, sinus rhythm maintenance, heart failure, mineralocorticoid receptor antagonists, statins, ACE inhibitors, angiotensin receptor blockers, cardiac rehabilitation, rhythm control therapy
- MeSH terms
- Diet, Healthy, Aged, Mineralocorticoid Receptor Antagonists, Angiotensin-Converting Enzyme Inhibitors, Atrial Fibrillation, Counseling, Exercise Therapy, Female, Heart Failure, Humans, Male, Middle Aged, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Risk Reduction Behavior
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