New Analysis Presents Snapshot of Management of Patients Hospitalized with a First Episode of Atrial Fibrillation

Less than half of the patients with first-detected atrial fibrillation (AFib) receive rhythm control at admission, according to data analysis from the nationwide Get With The Guidelines®-Atrial Fibrillation Registry (GWTG-AF).

In a study published in the Heart Rhythm Journal, data from patients hospitalized with first-detected AFib from 2013-2019 were analyzed using the GWTG-AF Registry. Of the 86,759 patients with AFib, 15,473 (17.8%) had first-detected AFib and 11,685 patients were included from 126 sites.

AFib is the most common arrhythmia associated with hospital admissions, accounting for more than 450,000 hospitalizations each year in the United States. AFib is associated with substantial morbidity (stroke, cognitive decline, heart failure), mortality, and health care expenditures. Early rhythm control has been shown to arrest the progression of AFib and improve patient outcomes. However, there is no consensus on optimal management of patients admitted with their first episode of AFib.

“Approximately one in five hospital admissions for AFib is for first-detected AFib,” said Jonathan P. Piccini, MD, a study author, DCRI faculty member, and director of cardiac electrophysiology at the Duke University School of Medicine. “This is one of the first studies to focus on these patients and is an important step towards understanding how they are treated in clinical practice. The results of this study emphasize the importance of CHANGE AFib, a pragmatic, randomized clinical trial being conducted by DCRI and the American Heart Association, with support from Sanofi US.” CHANGE AFib will determine if early initiation of rhythm control with a well-tolerated antiarrhythmic drug in patients with first-detected AFib improves outcomes. Specifically, CHANGE AFib will compare dronedarone with usual care alone for the prevention of cardiovascular hospitalization or death. It is the first pragmatic trial to focus on identifying treatment best practices for first-detected AFib.

“We increasingly realize the importance of early rhythm control in preventing progression of AFib,” said lead study author Devika Kir, MD, a cardiology fellow at the University of Miami/Jackson Memorial Hospital/VA Miami. “However, despite multiple trials, there are still no definite guidelines to guide management and choose rhythm over rate control for patients presenting with their first episode of AFib. Our study raises many pertinent questions about our current practices and would help devise treatment algorithms to improve outcomes for patients with AFib.”

The Heart Rhythm Journal study provides a snapshot of the contemporary management practices for first-detected AFib. The analysis found that more patients were treated with planned rate control (51.3%) than rhythm control (48.7% on admission). Rhythm control effectively maintained sinus rhythm at discharge in around 73% of the patients compared to 34% for intended rate control.

Those managed with a planned rhythm control strategy had a shorter hospital stay and were more likely to be discharged home than to a facility. They were also more likely to be discharged on anticoagulation compared to planned rate control (75.6% vs. 70.9%) despite a higher underlying stroke risk in the rate control group. The likelihood of rhythm control decreased with age 70 or above, liver disease, Hispanic ethnicity, and Medicaid insurance. Factors including heart failure, stroke, or prior bleeding had no association with the choice of the treatment strategy. 

Other DCRI authors include Shuaiqi Zhang, MS; Lisa A. Kaltenback, MS; and Ronald Matsouaka, PhD

The American Heart Association provides the GWTG-AFIB program, and GWTG-AF is sponsored, in part, by Novartis and BMS Pfizer.