Does intensity of rate-control influence outcome in atrial fibrillation? An analysis of pooled data from the RACE and AFFIRM studies

Van Gelder, Isabelle C.; Wyse, D. George; Chandler, Mary L.; Cooper, Howard A.; Olshansky, Brian; Hagens, Vincent E.; Crijns, Harry J.G.M.

doi:10.1093/europace/eul106

Cited by 165Atrial Fibrillation Management and OutcomesCardiac pacing and defibrillation studiesHeart rate and cardiovascular health

Does intensity of rate-control influence outcome in atrial fibrillation? An analysis of pooled data from the RACE and AFFIRM studies

Van Gelder, Isabelle C., Wyse, D. George, Chandler, Mary L., Cooper, Howard A., Olshansky, Brian, Hagens, Vincent E., Crijns, Harry J.G.M.·2006·EP Europace

DOI 10.1093/europace/eul106

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Abstract

AIMS: The AFFIRM and RACE studies showed that rate control is an acceptable treatment strategy for atrial fibrillation (AF). We examined whether strict rate control offers benefit over more lenient rate control. METHODS AND RESULTS: We compared the outcome of patients enrolled in the rate-control arms of AFFIRM and RACE, using data from patients who met a composite of overlapping inclusion and exclusion criteria. We evaluated 1091 patients, 874 from AFFIRM and 217 from RACE. In AFFIRM, the rate-control strategy aimed for a resting heart rate < or =80 bpm and heart rate during daily activity of < or =110 bpm. In RACE, a more lenient approach was taken: resting heart rate <100 bpm. Primary endpoint was a composite of mortality, cardiovascular hospitalization, and myocardial infarction. Mean heart rate across all follow-up visits for patients in AF was lower in AFFIRM (76.1 vs. 83.4 bpm). Event-free survival for the occurrence of the primary endpoint did not differ (64% in AFFIRM vs. 66% in RACE). Patients with mean heart rates during AF within the AFFIRM (< or =80) or RACE (<100) criteria had a better outcome than patients with heart rates > or =100 (hazard ratios 0.69 and 0.58, respectively, for < or =80 and <100 compared with > or =100 bpm). CONCLUSION: Stringency of the approach to rate control, based on the comparison of the AFFIRM and RACE studies, was not associated with an important difference in clinical events.

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In a pooled analysis of the AFFIRM and RACE trials (1091 participants), similar results were found, albeit with smaller heart rate differences and without randomization.
“Similar results were found in a pooled analysis of the AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) and RACE trials (1091 participants), albeit with smaller heart rate differences and without randomization.562”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [562]

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RAte Control Efficacy in permanent atrial fibrillation: a comparison between lenient versus strict rate control in patients with and without heart failure. Background, aims, and design of RACE II
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Self-citation

Authors: Van Gelder, I. C., Wyse, D. G., Chandler, M. L., Cooper, H. A., Olshansky, B., Hagens, V. E., & Crijns, H. J. G. M.
Affiliations: Libin Cardiovascular Institute of Alberta (CA)
MedStar Washington Hospital Center (US)
University of Iowa (US)
University Medical Center Groningen (NL)
Maastricht University Medical Centre (NL)
ORCID: Olshansky, Brian
Crijns, Harry J.G.M.
Venue: EP Europace
Publisher: Oxford University Press (OUP)
Published: 2006-09-14
Volume: 8
Issue: 11
Pages: 935-942
ISSN: 1099-5129 (ISSN-L)
1532-2092
DOI: 10.1093/europace/eul106
OpenAlex: W2117915052
Cited by: 165
References: 17
Citations by year: 2026: 3 · 2025: 5 · 2024: 7 · 2023: 12 · 2022: 9 · 2021: 13 · 2020: 12 · 2019: 3 · 2018: 7 · 2017: 13 · 2016: 8 · 2015: 7 · 2014: 6 · 2013: 9 · 2012: 7
FWCI: 5.71
Type: journal article
Language: en
Open access: closed
Locations: EP Europace (publishedVersion)
PubMed (publishedVersion)
University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
Funders: National Institutes of Health (n01hc055139-000)
National Heart, Lung, and Blood Institute (N01-HC-55139)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
Keywords: atrial fibrillation, rate control, resting heart rate, target heart rate, event-free survival, mortality, cardiovascular hospitalization, myocardial infarction, AFFIRM trial, pooled analysis
MeSH terms: Aged, Atrial Fibrillation, Cardiac Pacing, Artificial, Clinical Trials as Topic, Female, Heart Rate, Humans, International Cooperation, Male, Middle Aged, Prognosis, Retrospective Studies, Risk Factors, Survival Rate, Proportional Hazards Models, Survival Analysis, Treatment Outcome, Outcome Assessment, Health Care, Risk Assessment

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Does intensity of rate-control influence outcome in atrial fibrillation? An analysis of pooled data from the RACE and AFFIRM studies

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