CLINICAL RESEARCH: ELECTROPHYSIOLOGY
Effect of rate or rhythm control on quality of life in persistent atrial fibrillation
Results from the Rate Control Versus Electrical Cardioversion (RACE) study
Vincent E. Hagens, MD*,
Adelita V. Ranchor, PhD ,
Eric Van Sonderen, PhD,
Hans A. Bosker, MD ,
Otto Kamp, MD ,
Jan G. P. Tijssen, PhD||,
J. Herre Kingma, MD¶,
Harry J. G. M. Crijns, MD#,
Isabelle C. Van Gelder, MD*,* the RACE Study Group**
* Department of Cardiology, University Hospital, Groningen, Netherlands
Northern Center for Healthcare Research, Groningen, Netherlands
Department of Cardiology, Rijnstate Hospital, Arnhem, Netherlands
Free University Medical Center, Amsterdam, Netherlands
|| Academic Medical Center, Amsterdam, Netherlands
¶ St. Antonius Hospital, Nieuwegein, Netherlands (at present Inspector-General of Health Care of the Netherlands)
# University Hospital, Maastricht, Netherlands
** Participants in the RACE for Persistent Atrial Fibrillation Study are listed elsewhere (1), Netherlands
Manuscript received March 25, 2003;
revised manuscript received June 20, 2003,
accepted August 11, 2003.
* Reprint requests and correspondence: Dr. Isabelle C. Van Gelder, Department of Cardiology, Thoraxcenter, University Hospital Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
I.C.van.Gelder{at}thorax.azg.nl
OBJECTIVES: We studied the influence of rate control or rhythm control in patients with persistent atrial fibrillation (AF) on quality of life (QoL).
BACKGROUND: Atrial fibrillation may cause symptoms like fatigue and dyspnea. This can impair QoL. Treatment of AF with either rate or rhythm control may influence QoL.
METHODS: Quality of life was assessed in patients included in the Rate Control Versus Electrical Cardioversion for Persistent Atrial Fibrillation (RACE) study (rate vs. rhythm control in persistent AF). Rate control patients (n = 175) were given negative chronotropic drugs and oral anticoagulation. Rhythm control patients (n = 177) received serial electrocardioversion, antiarrhythmic drugs, and oral anticoagulation, as needed. Quality of life was studied using the Short Form (SF)-36 health survey questionnaire at baseline, one year, and the end of the study (after 2 to 3 years of follow-up). At baseline, QoL was compared with that of healthy control subjects. Patient characteristics related to QoL changes were determined.
RESULTS: Mean follow-up was 2.3 years. At baseline, QoL was lower in patients than in age-matched healthy controls. At study end, under rate control, three subscales of the SF-36 improved. Under rhythm control, no significant changes occurred compared with baseline. At study end, QoL was comparable between both groups. The presence of complaints of AF at baseline, a short duration of AF, and the presence of sinus rhythm (SR) at the end of follow-up, rather than the assigned strategy, were associated with QoL improvement.
CONCLUSIONS: Quality of life is impaired in patients with AF compared with healthy controls. Treatment strategy does not affect QoL. Patients with complaints related to AF, however, may benefit from rhythm control if SR can be maintained.
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Abbreviations and Acronyms
| | AF | = atrial fibrillation | | AFFIRM | = Atrial Fibrillation Follow-up Investigation of Rhythm Management trial | | CTAF | = Canadian Trial of Atrial Fibrillation trial | | HF | = heart failure | | NYHA | = New York Heart Association | | PIAF | = Pharmacological Intervention in Atrial Fibrillation trial | | QoL | = quality of life | | RACE | = Rate Control Versus Electrical Cardioversion for Persistent Atrial Fibrillation trial | | SF-36 | = Short-Form 36 | | SR | = sinus rhythm |
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