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 .
The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study: approaches to control rate in atrial fibrillation.
OBJECTIVES We sought to evaluate approaches used to control rate , the effectiveness of rate control , and switches from one drug class to another in the Atrial Fibrillation Follow-up Investigation of Rhythm Management ( AFFIRM ) study . BACKGROUND The AFFIRM study showed that atrial fibrillation ( AF ) can be treated effectively with rate control and anticoagulation , but drug efficacy to control rate remains uncertain . METHODS Patients ( n = 2,027 ) r and omized to rate control in the AFFIRM study were given rate-controlling drugs by their treating physicians . St and ardized rate-control efficacy criteria developed a priori included resting heart rate and 6-min walk tests and /or ambulatory electrocardiographic results . RESULTS Average follow-up was 3.5 + /- 1.3 years . Initial treatment included a beta-adrenergic blocker ( beta-blocker ) alone in 24 % , a calcium channel blocker alone in 17 % , digoxin alone in 16 % , a beta-blocker and digoxin in 14 % , or a calcium channel blocker and digoxin in 14 % of patients . Overall rate control was achieved in 70 % of patients given beta-blockers as the first drug ( with or without digoxin ) , 54 % with calcium channel blockers ( with or without digoxin ) , and 58 % with digoxin alone . Adequate overall rate control was achieved in 58 % of patients with the first drug or combination . Multivariate analysis revealed an association between first drug class and several clinical variables . There were more changes to beta-blockers than to the other two-drug classes ( p < 0.0001 ) . CONCLUSIONS Rate control in AF is possible in the majority of patients with AF . Beta-blockers were the most effective drugs . To achieve the goal of adequate rate control in all patients , frequent medication changes and drug combinations were needed
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 .