TY - JOUR
T1 - Targeted therapy of underlying conditions improves quality of life in patients with persistent atrial fibrillation
T2 - results of the RACE 3 study
AU - De With, Ruben R
AU - Rienstra, Michiel
AU - Smit, Marcelle D
AU - Weijs, Bob
AU - Zwartkruis, Victor W
AU - Hobbelt, Anne H
AU - Alings, Marco
AU - Tijssen, Jan G P
AU - Brügemann, Johan
AU - Geelhoed, Bastiaan
AU - Hillege, Hans L
AU - Tukkie, Raymond
AU - Hemels, Martin E
AU - Tieleman, Robert G
AU - Ranchor, Adelita V
AU - Van Veldhuisen, Dirk J
AU - Crijns, Harry J G M
AU - Van Gelder, Isabelle C
N1 - Funding Information:
Conflict of interest: M.A. reports personal fees from Bayer, Boehringer-Ingelheim, Daiichi-Sankyo, Bristol-Myers-Squibb, Pfizer, and Sanofi. R.G.T. reports grants and personal fees from Bayer, Bristol-Myers-Squibb, Pfizer, and Daiichi-Sankyo. All other authors have no competing interests.
Funding Information:
This work was supported by the Netherlands Heart Foundation [grant 2008B035]. Unrestricted grants from AstraZeneca, Bayer, Biotronik, Boehringer-Ingelheim, Boston Scientific, Medtronic, Sanofi-Aventis, and St Jude Medical paid to the Netherlands Heart Institute.
Publisher Copyright:
© 2019 The Author(s).
PY - 2019/4/1
Y1 - 2019/4/1
N2 - Aims Atrial fibrillation (AF) reduces quality of life (QoL). We aim to evaluate effects of targeted therapy of underlying conditions on QoL in patients with AF and heart failure (HF). Methods and results The Routine versus Aggressive risk factor driven upstream rhythm Control for prevention of Early atrial fibrillation in heart failure (RACE 3) study randomized patients with early persistent AF and HF to targeted or conventional therapy. Both groups received guideline-driven treatment. The targeted group received four additional therapies: Mineralocorticoid receptor antagonists; statins; angiotensin converting enzyme inhibitors and/or receptor blockers; and cardiac rehabilitation including physical activity, dietary restrictions, and counselling. Quality of life was analysed in 230 patients at baseline and 1 year with available Medical Outcomes Study Short-Form Health Survey (SF-36), University of Toronto AF Severity Scale (AFSS) questionnaires, and European Heart Rhythm Association (EHRA) class. Improvements in SF-36 subscales were larger in the targeted group for physical functioning (Δ;12 ± 19 vs. Δ6 ± 22, P = 0.007), physical role limitations (Δ32 ± 41 vs. Δ17 ± 45, P = 0.018), and general health (Δ8 ± 16 vs. Δ0 ± 17, P < 0.001). Dyspnoea at rest improved more (Δ-0.8 ± 1.3 vs. Δ-0.4 ± 1.2, P = 0.018) and EHRA class was lower at 1-year follow-up in the targeted group. Patients with AF at 1 year, improvement in physical functioning (Δ9 ± 9 vs. Δ-3 ± 16, P = 0.001), general health (Δ7 ± 16 vs. Δ-7 ± 19, P = 0.004), and social functioning (Δ6 ± 23 vs. Δ-4 ± 16, P = 0.041) were larger in the targeted group. Conclusion A strategy aiming to treat underlying conditions improved QoL more compared with conventional therapy in patients with early persistent AF and HF. Its benefit was even observed in patients in AF at 1 year.
AB - Aims Atrial fibrillation (AF) reduces quality of life (QoL). We aim to evaluate effects of targeted therapy of underlying conditions on QoL in patients with AF and heart failure (HF). Methods and results The Routine versus Aggressive risk factor driven upstream rhythm Control for prevention of Early atrial fibrillation in heart failure (RACE 3) study randomized patients with early persistent AF and HF to targeted or conventional therapy. Both groups received guideline-driven treatment. The targeted group received four additional therapies: Mineralocorticoid receptor antagonists; statins; angiotensin converting enzyme inhibitors and/or receptor blockers; and cardiac rehabilitation including physical activity, dietary restrictions, and counselling. Quality of life was analysed in 230 patients at baseline and 1 year with available Medical Outcomes Study Short-Form Health Survey (SF-36), University of Toronto AF Severity Scale (AFSS) questionnaires, and European Heart Rhythm Association (EHRA) class. Improvements in SF-36 subscales were larger in the targeted group for physical functioning (Δ;12 ± 19 vs. Δ6 ± 22, P = 0.007), physical role limitations (Δ32 ± 41 vs. Δ17 ± 45, P = 0.018), and general health (Δ8 ± 16 vs. Δ0 ± 17, P < 0.001). Dyspnoea at rest improved more (Δ-0.8 ± 1.3 vs. Δ-0.4 ± 1.2, P = 0.018) and EHRA class was lower at 1-year follow-up in the targeted group. Patients with AF at 1 year, improvement in physical functioning (Δ9 ± 9 vs. Δ-3 ± 16, P = 0.001), general health (Δ7 ± 16 vs. Δ-7 ± 19, P = 0.004), and social functioning (Δ6 ± 23 vs. Δ-4 ± 16, P = 0.041) were larger in the targeted group. Conclusion A strategy aiming to treat underlying conditions improved QoL more compared with conventional therapy in patients with early persistent AF and HF. Its benefit was even observed in patients in AF at 1 year.
KW - Atrial fibrillation
KW - Quality of life
KW - Randomized clinical trial
KW - Risk factor
KW - Targeted therapy
UR - http://www.scopus.com/inward/record.url?scp=85064497906&partnerID=8YFLogxK
U2 - 10.1093/europace/euy311
DO - 10.1093/europace/euy311
M3 - Article
C2 - 30629160
SN - 1099-5129
VL - 21
SP - 563
EP - 571
JO - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
JF - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
IS - 4
ER -