In patients with AF and HF , rate control compared with rhythm control showed inferior risk of hospitalisation
BACKGROUND Atrial fibrillation ( AF ) is a common arrhythmia that can promote or worsen heart failure ( HF ) .
Our purpose was to compare the effects of rate and rhythm control in patients with atrial fibrillation and heart failure .
Monitoring anticoagulation in atrial fibrillation
Abstract Background : R and omized control trials and observational studies show high- quality warfarin therapy leads to safe and effective stroke prophylaxis . In usual community practice , patient , physician and health care system factors are barriers to optimal anticoagulation . We examined the predictive relationship between inpatient and outpatient INR values in chronic non-valvular atrial fibrillation ( AF ) patients hospitalized for ischemic stroke ( S ) , bleed ( B ) and control events ( C ) in usual community practice . Methods : This nested case-control analysis identified AF patients hospitalized for S , B and C using medical and pharmacy cl aims spanning 4.5 years ( ‘ 98–‘03 ) and validating diagnosis with chart abstract ion . AF was defined as 2 medical cl aims for AF ≥ 42 days apart with a related prescription cl aim for warfarin . INRs from both outpatient and inpatient setting s were used to yield a continuous history of coagulation status . Time-in-therapeutic-range ( TTR ) was calculated by Rosendaal ’s linear interpolation method . Correlation of inpatient and prognostic utility of last outpatient INRs was tested with S or B hospitalizations using univariate and multivariate logistic regression . Results : Overall , 614 hospitalizations ( means : age 73.9 , CHADS2 = 3.24 ; 52 % male ) included S ( n = 98 ) , B ( n = 101 ) and C ( n = 415 ) events . Average TTR was 28.6 % ( 49.4 % at INR < 2.0 , 21.9 % at INR > 3.0 ) . First INR on admission ( INR < 2.0 or > 3.0 ) was associated with S and B hospitalizations ( OR-adjusted [ 95%CI ] , 1.68 [ 1.04–2.73 ] and 1.72 [ 1.02–2.90 ] ) , respectively . Last outpatient INR < 2.0 was not associated with S ( OR-adjusted [ 95%CI ] , 1.12 [ 0.77–1.81 ] ) , and INR > 3.0 was not associated with B ( OR-adjusted [ 95%CI ] , 1.25 [ 0.67–2.32 ] ) . Last outpatient INR measurement occurred at 28 , 22 and 24 days ( median ; S , B & C , respectively ) before hospitalization . Conclusion : Patients were observed within therapeutic range less than 30 % of their time on warfarin . While inpatient INRs were clearly associated with both ischemic stroke and bleed events , last outpatient INR before event was not predictive
In patients with AF and HF , rate control compared with rhythm control showed inferior risk of hospitalisation
BACKGROUND Atrial fibrillation ( AF ) is a common arrhythmia that can promote or worsen heart failure ( HF ) .
Our purpose was to compare the effects of rate and rhythm control in patients with atrial fibrillation and heart failure .