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CLINICAL RESEARCH

Gender-Related Differences in Rhythm Control Treatment in Persistent Atrial Fibrillation

Data of the Rate Control Versus Electrical Cardioversion (RACE) Study

Michiel Rienstra, MD^_*, Dirk J. Van Veldhuisen, MD, FACC^_*, Vincent E. Hagens, MD^_*, Adelita V. Ranchor, PhD, Nic J.G.M. Veeger, MSc, Harry J.G.M. Crijns, MD, Isabelle C. Van Gelder, MD^_*,_* for the RACE Investigators

^_* Department of Cardiology, University Medical Center, University of Groningen, Groningen, the Netherlands
Northern Center for Healthcare Research, Groningen, the Netherlands
University Hospital, Maastricht, the Netherlands
Trial Coordination Center, University Medical Center, Groningen, the Netherlands

Manuscript received February 7, 2005; revised manuscript received April 19, 2005, accepted May 15, 2005.

^_* Reprint requests and correspondence: Dr. Isabelle C. Van Gelder, Department of Cardiology, Thoraxcenter, University Medical Center, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands (Email: I.C.van.Gelder{at}thorax.umcg.nl).

OBJECTIVES: This study sought to compare whether gender affects the outcome of rate versus rhythm control treatment in patients with persistent atrial fibrillation (AF).

BACKGROUND: Large trials have shown that rate control is an acceptable alternative to rhythm control. However, the effects of treatment may differ between male and female patients.

METHODS: In the Rate Control versus Electrical Cardioversion (RACE) study, 522 patients (192 female) were included and randomized to rate or rhythm control. The occurrence of cardiovascular end points and quality of life (QoL) were compared between female and male patients.

RESULTS: At baseline, female patients differed from male patients with regard to age, underlying heart disease, diabetes mellitus, and left ventricular function. Female patients had more AF-related complaints, and QoL was significantly lower. After a mean follow-up of 2.3 ± 0.6 years, cardiovascular morbidity and mortality was equally distributed between female (21%) and male patients (19%). However, in contrast to male patients, female patients randomized to rhythm control developed more end points (adjusted hazard ratio was 3.1 [95% confidence interval 1.5 to 6.3], p = 0.002), mainly heart failure, thromboembolic complications, and adverse effects of antiarrhythmic drugs, compared with rate control randomized female patients. During follow-up, QoL in female patients remained worse compared with that for male patients. Randomized strategy did not influence QoL in female patients.

CONCLUSIONS: In female patients with persistent AF, a rhythm control approach leads to more cardiovascular morbidity and mortality. Because treatment strategy did not influence QoL in female patients, a rate control approach may be considered in these patients.

Abbreviations and Acronyms   AF = atrial fibrillation   AFFIRM = Atrial Fibrillation Follow-up Investigation of Rhythm Management   CI = confidence interval   HR = hazard ratio   INR = international normalized ratio   NYHA = New York Heart Association   QoL = quality of life   RACE = Rate Control versus Electrical Cardioversion study   SF-36 = Medical Outcomes Study Short-Form Health Survey   SPAF = Stroke Prevention in Atrial Fibrillation

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