They also have an increased risk for thromboembolism .
Comparing with age-matched controls , the relative risk for stroke is increased 2- to 7-fold in patients with nonrheumatic atrial fibrillation ( 3 , 8 , 13 ) , and the absolute risk for stroke is between 1 % and 5 % per year , depending on clinical characteristics ( 3 , 12 , 14 - 16 ) .
Paroxysmal atrial fibrillation disrupts the lives of patients ( 17 ) , but this perception may not be associated with frequency or duration of symptoms .
Warfarin therapy affects quality of life because of frequent blood testing and recommendations for limiting some activities .
Data Synthesis Does Aggressive Rhythm Control Improve Mortality and Morbidity Compared with Rate Control ?
Atrial fibrillation is the most common type of arrhythmia in adults , accounting for about one third of hospitalizations for arrhythmia ( 1 ) .
The prevalence increases from less than 1 % in persons younger than 60 years of age to more than 8 % in those older than 80 years of age ( 2 - 6 ) .
The incidence ranges from 0.2 % per year for men 30 to 39 years of age to 2.3 % per year in men 80 to 89 years of age ( 7 , 8) .
The age-adjusted incidence for women is about half that of men ( 9 ) .
The cardiac conditions most commonly associated with atrial fibrillation are rheumatic mitral valve disease , coronary artery disease , congestive heart failure , and hypertension ( 8 , 10 ) .
Noncardiac causes include hyperthyroidism , hypoxic conditions , surgery , and alcohol intoxication .
A predisposing condition exists in more than 90 % of cases ( 5 , 11 , 12 ) ; the remaining cases have what is called lone atrial fibrillation .
Patients with atrial fibrillation frequently have symptoms of hemodynamic compromise , ranging from irregular palpitations to the more insidious feeling of malaise .
Little is known about the direct effects of antiarrhythmic therapy and rate-control therapy on quality of life .
The American College of Cardiology/American Heart Association/European Society of Cardiology Task Force on Clinical Guidelines for the Management of Atrial Fibrillation classified atrial fibrillation into 4 types ( 20 ) : first detected episode , paroxysmal ( terminates spontaneously ) , persistent ( electrical or pharmacologic termination necessary ) , and permanent ( resistant to electrical or pharmacologic conversion or accepted by the physician ) .
The purpose of this review was to summarize the evidence that was available during formulation of the guidelines developed by the American College of Physicians ( ACP ) and the American Academy of Family Physicians ( AAFP ) for management of adult patients with nonpostoperative atrial fibrillation .
Although the relative benefits and risks of rate versus rhythm control are of paramount importance in the management of atrial fibrillation , studies directly addressed this issue only recently .
Optimal intensity of warfarin therapy for secondary prevention of stroke in patients with nonvalvular atrial fibrillation : a multicenter, prospective, randomized trial. Japanese Nonvalvular Atrial Fibrillation-Embolism Secondary Prevention Cooperative Study Group.
BACKGROUND AND PURPOSE The optimal intensity of warfarin therapy for secondary prevention of stroke in nonvalvular atrial fibrillation ( NVAF ) remains unclear . We studied the efficacy and safety of conventional- and low-intensity warfarin therapy in a prospect i ve , r and omized , multicenter trial . METHODS The study population consisted of patients with NVAF ( < 80 years old ) who had a stroke or transient ischemic attack . The patients were r and omly allocated into a conventional-intensity group ( international normalized ratio [ INR ] 2.2 to 3.5 ) and a low-intensity group ( INR 1.5 to 2.1 ) . They were carefully monitored , and the annual rate of recurrent ischemic stroke and major hemorrhagic complications were compared between the groups . RESULTS We enrolled 115 patients ( mean age 66.7+/-6.5 years ) into the study . Fifty-five and 60 patients were allocated into the conventional- and low-intensity groups , respectively . The trial was stopped after a follow-up of 658+/-423 days , when major hemorrhagic complications occurred in 6 patients of the conventional-intensity group and the frequency ( 6.6 % per year ) was significantly higher than that in the low-intensity group ( 0 % per year , P=0.01 , Fisher 's exact test ) . All of the 6 patients with major bleeding were elderly ( mean age 74 years ) , and their mean  INR  before the major hemorrhage was 2.8 . The annual rate of ischemic stroke was low in both groups ( 1.1 % per year in the conventional-intensity group and 1.7 % per year in the low-intensity groups ) and did not differ significantly . CONCLUSIONS For secondary prevention of stroke in persons with NVAF , especially in old patients , the low-intensity warfarin ( INR 1.5 to 2 . 1 ) treatment seems to be safer than the conventional-intensity ( INR 2.2 to 3.5 ) treatment
They also have an increased risk for thromboembolism .
Comparing with age-matched controls , the relative risk for stroke is increased 2- to 7-fold in patients with nonrheumatic atrial fibrillation ( 3 , 8 , 13 ) , and the absolute risk for stroke is between 1 % and 5 % per year , depending on clinical characteristics ( 3 , 12 , 14 - 16 ) .
Paroxysmal atrial fibrillation disrupts the lives of patients ( 17 ) , but this perception may not be associated with frequency or duration of symptoms .
Warfarin therapy affects quality of life because of frequent blood testing and recommendations for limiting some activities .
Data Synthesis Does Aggressive Rhythm Control Improve Mortality and Morbidity Compared with Rate Control ?
Atrial fibrillation is the most common type of arrhythmia in adults , accounting for about one third of hospitalizations for arrhythmia ( 1 ) .
The prevalence increases from less than 1 % in persons younger than 60 years of age to more than 8 % in those older than 80 years of age ( 2 - 6 ) .
The incidence ranges from 0.2 % per year for men 30 to 39 years of age to 2.3 % per year in men 80 to 89 years of age ( 7 , 8) .
The age-adjusted incidence for women is about half that of men ( 9 ) .
The cardiac conditions most commonly associated with atrial fibrillation are rheumatic mitral valve disease , coronary artery disease , congestive heart failure , and hypertension ( 8 , 10 ) .
Noncardiac causes include hyperthyroidism , hypoxic conditions , surgery , and alcohol intoxication .
A predisposing condition exists in more than 90 % of cases ( 5 , 11 , 12 ) ; the remaining cases have what is called lone atrial fibrillation .
Patients with atrial fibrillation frequently have symptoms of hemodynamic compromise , ranging from irregular palpitations to the more insidious feeling of malaise .
Little is known about the direct effects of antiarrhythmic therapy and rate-control therapy on quality of life .
The American College of Cardiology/American Heart Association/European Society of Cardiology Task Force on Clinical Guidelines for the Management of Atrial Fibrillation classified atrial fibrillation into 4 types ( 20 ) : first detected episode , paroxysmal ( terminates spontaneously ) , persistent ( electrical or pharmacologic termination necessary ) , and permanent ( resistant to electrical or pharmacologic conversion or accepted by the physician ) .
The purpose of this review was to summarize the evidence that was available during formulation of the guidelines developed by the American College of Physicians ( ACP ) and the American Academy of Family Physicians ( AAFP ) for management of adult patients with nonpostoperative atrial fibrillation .
Although the relative benefits and risks of rate versus rhythm control are of paramount importance in the management of atrial fibrillation , studies directly addressed this issue only recently .