Discussion The results of this systematic review have the potential to benefit thous and s of patients worldwide as well as healthcare systems and healthcare economy .
Background Atrial fibrillation is the most common arrhythmia of the heart with a prevalence of approximately 2 % in the western world .
Atrial flutter , another arrhythmia , occurs less often with an incidence of approximately 200,000 new patients per year in the USA .
Patients with atrial fibrillation and atrial flutter have an increased risk of death and morbidities .
The management of atrial fibrillation and atrial flutter is often based on interventions aim ing at either a rhythm control strategy or a rate control strategy .
The evidence on the comparable effects of these strategies is unclear .
This protocol for a systematic review aims at identifying the best overall treatment strategy for atrial fibrillation and atrial flutter .
Rate-Control Treatment and Mortality in Atrial Fibrillation
Background — Current American and European guidelines emphasize the importance of rate-control treatments in treating atrial fibrillation with a Class I recommendation , although data on the survival benefits of rate control are lacking . The goal of the present study was to investigate whether patients receiving rate-control drugs  had a better prognosis compared with those without rate-control treatment . Methods and Results — This study used the National Health Insurance Research Data base in Taiwan . There were 43 879 , 18 466 , and 38 898 patients with atrial fibrillation enrolled in the groups receiving & bgr;-blockers , calcium channel blockers , and digoxin  , respectively . The reference group consisted of 168 678 subjects who did not receive any rate-control drug .  The clinical end point was all-cause mortality . During a follow-up of 4.9±3.7 years , mortality occurred in 88 263 patients ( 32.7 % ) . After adjustment for baseline differences , the risk of mortality was lower in patients receiving & bgr;-blockers ( adjusted hazard ratio=0.76 ; 95 % confidence interval=0.74–0.78 ) and calcium channel blockers ( adjusted hazard ratio=0.93 ; 95 % confidence interval=0.90–0.96 ) compared with those who did not receive rate-control medications . On the contrary , the digoxin group had a higher risk of mortality with an adjusted hazard ratio of 1.12 ( 95 % confidence interval=1.10–1.14 ) . The results were observed consistently in subgroup analyses and among the cohorts after propensity matching . Conclusions — In this nationwide atrial fibrillation cohort  , the risk of mortality was lower for patients  receiving rate-control treatment with & bgr;-blockers or calcium channel blockers , and the use of & bgr;-blockers was associated with the largest risk reduction . Digoxin use was associated with greater mortality . Prospect i ve , r and omized trials are necessary to confirm these findings
Discussion The results of this systematic review have the potential to benefit thous and s of patients worldwide as well as healthcare systems and healthcare economy .
Background Atrial fibrillation is the most common arrhythmia of the heart with a prevalence of approximately 2 % in the western world .
Atrial flutter , another arrhythmia , occurs less often with an incidence of approximately 200,000 new patients per year in the USA .
Patients with atrial fibrillation and atrial flutter have an increased risk of death and morbidities .
The management of atrial fibrillation and atrial flutter is often based on interventions aim ing at either a rhythm control strategy or a rate control strategy .
The evidence on the comparable effects of these strategies is unclear .
This protocol for a systematic review aims at identifying the best overall treatment strategy for atrial fibrillation and atrial flutter .