As such , evidence was insufficient to recommend rhythm or rate control as the first-line therapy for AF in older adults .
Atrial fibrillation ( AF ) is highly prevalent in older adults and has been associated with increased morbidity and mortality .
To reduce this AF-related morbidity in older adults , antiarrhythmic drugs ( AADs ) are regularly used for rhythm control , assuming that increasing time in sinus rhythm reduces AF-related morbidity .
However , whether AADs can improve clinical outcomes in older adults remains unclear because of the increased risk for adverse drug events compared with rate control .
The aim of this study was to determine the impact of rhythm control versus rate control on clinical outcomes in older adults with AF .
Quality of life in atrial fibrillation: the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study.
OBJECTIVE The objective of this prespecified sub study of the AFFIRM study , in which no differences in survival or event rates were found in patients with atrial fibrillation ( AF ) r and omized to either rate control or rhythm control , was to test the null hypothesis that quality of life ( QoL ) is equal with rate- versus rhythm-control treatment strategies in AF . METHODS Fifty-six ( 25 % ) of AFFIRM sites were r and omly selected to recruit AFFIRM patients for the QoL sub study . Instruments used in the QoL assessment were ( 1 ) Perceived Health ;  ( 2 ) the  Cantril Ladder of Life ;  ( 3 ) the  Short Form 36 survey ;  ( 4 ) the  QoL Index ;  and ( 5 ) the  Symptom Checklist : Frequency and Severity .  Data were collected at baseline , 2 months , 12 months , and annually ; data are reported through 4 years of follow-up . RESULTS Baseline characteristics of the AFFIRM QoL patients ( n = 716 ) were generally similar to those of the rest of AFFIRM patients .  Quality -of-life scores were similar in rate- and rhythm-control assignment groups at all time points . Quality -of-life scores were similar whether the actual rhythm was sinus or AF . Scores increased from baseline to subsequent time points similarly for both groups ; these improvements were not additive over time . CONCLUSIONS Quality of life was comparable between rate- and rhythm-control treatment strategies . In addition , QoL was similar with sinus rhythm versus AF . Attempts to improve QoL by restoring sinus rhythm will usually be unsuccessful
As such , evidence was insufficient to recommend rhythm or rate control as the first-line therapy for AF in older adults .
Atrial fibrillation ( AF ) is highly prevalent in older adults and has been associated with increased morbidity and mortality .
To reduce this AF-related morbidity in older adults , antiarrhythmic drugs ( AADs ) are regularly used for rhythm control , assuming that increasing time in sinus rhythm reduces AF-related morbidity .
However , whether AADs can improve clinical outcomes in older adults remains unclear because of the increased risk for adverse drug events compared with rate control .
The aim of this study was to determine the impact of rhythm control versus rate control on clinical outcomes in older adults with AF .