TY - JOUR
T1 - Targeted therapy of underlying conditions improves sinus rhythm maintenance in patients with persistent atrial fibrillation
T2 - results of the RACE 3 trial
AU - Rienstra, Michiel
AU - Hobbelt, Anne H
AU - Alings, Marco
AU - Tijssen, Jan G P
AU - Smit, Marcelle D
AU - Brügemann, Johan
AU - Geelhoed, Bastiaan
AU - Tieleman, Robert G
AU - Hillege, Hans L
AU - Tukkie, Raymond
AU - Van Veldhuisen, Dirk J
AU - Crijns, Harry J G M
AU - Van Gelder, Isabelle C
N1 - Funding Information:
Conflict of interest: M.R., A.H.H., M.A., J.G.P.T., M.D.S., J.B., B.G., R.G.T., H.J.H., R.T., D.J.V.V., H.J.G.M.C., and I.C.V.G. declare no competing interests. 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.
Funding Information:
The Netherlands Heart Foundation (Grant 2008B035); the Netherlands Heart Institute; Unrestricted grants from AstraZeneca, Bayer, Biotronik, Boehringer-Ingelheim, Boston Scientific, Medtronic, Sanofi-Aventis, St Jude Medical paid to the Netherlands Heart Institute.
Publisher Copyright:
© Published on behalf of the European Society of Cardiology. All rights reserved. VC The Author(s) 2018.
PY - 2018/8/21
Y1 - 2018/8/21
N2 - Aims: Atrial fibrillation (AF) is a progressive disease. Targeted therapy of underlying conditions refers to interventions aiming to modify risk factors in order to prevent AF. We hypothesised that targeted therapy of underlying conditions improves sinus rhythm maintenance in patients with persistent AF.Methods and results: We randomized patients with early persistent AF and mild-to-moderate heart failure (HF) to targeted therapy of underlying conditions or conventional therapy. Both groups received causal treatment of AF and HF, and rhythm control therapy. In the intervention group, on top of that, four therapies were started: (i) mineralocorticoid receptor antagonists (MRAs), (ii) statins, (iii) angiotensin converting enzyme inhibitors and/or receptor blockers, and (iv) cardiac rehabilitation including physical activity, dietary restrictions, and counselling. The primary endpoint was sinus rhythm at 1 year during 7 days of Holter monitoring. Of 245 patients, 119 were randomized to targeted and 126 to conventional therapy. The intervention led to a contrast in MRA (101 [85%] vs. 5 [4%] patients, P < 0.001) and statin use (111 [93%] vs. 61 [48%], P < 0.001). Angiotensin converting enzyme inhibitors/angiotensin receptor blockers were not different. Cardiac rehabilitation was completed in 109 (92%) patients. Underlying conditions were more successfully treated in the intervention group. At 1 year, sinus rhythm was present in 89 (75%) patients in the intervention vs. 79 (63%) in the conventional group (odds ratio 1.765, lower limit of 95% confidence interval 1.021, P = 0.042).Conclusions: RACE 3 confirms that targeted therapy of underlying conditions improves sinus rhythm maintenance in patients with persistent AF.Trial Registration number: Clinicaltrials.gov NCT00877643.
AB - Aims: Atrial fibrillation (AF) is a progressive disease. Targeted therapy of underlying conditions refers to interventions aiming to modify risk factors in order to prevent AF. We hypothesised that targeted therapy of underlying conditions improves sinus rhythm maintenance in patients with persistent AF.Methods and results: We randomized patients with early persistent AF and mild-to-moderate heart failure (HF) to targeted therapy of underlying conditions or conventional therapy. Both groups received causal treatment of AF and HF, and rhythm control therapy. In the intervention group, on top of that, four therapies were started: (i) mineralocorticoid receptor antagonists (MRAs), (ii) statins, (iii) angiotensin converting enzyme inhibitors and/or receptor blockers, and (iv) cardiac rehabilitation including physical activity, dietary restrictions, and counselling. The primary endpoint was sinus rhythm at 1 year during 7 days of Holter monitoring. Of 245 patients, 119 were randomized to targeted and 126 to conventional therapy. The intervention led to a contrast in MRA (101 [85%] vs. 5 [4%] patients, P < 0.001) and statin use (111 [93%] vs. 61 [48%], P < 0.001). Angiotensin converting enzyme inhibitors/angiotensin receptor blockers were not different. Cardiac rehabilitation was completed in 109 (92%) patients. Underlying conditions were more successfully treated in the intervention group. At 1 year, sinus rhythm was present in 89 (75%) patients in the intervention vs. 79 (63%) in the conventional group (odds ratio 1.765, lower limit of 95% confidence interval 1.021, P = 0.042).Conclusions: RACE 3 confirms that targeted therapy of underlying conditions improves sinus rhythm maintenance in patients with persistent AF.Trial Registration number: Clinicaltrials.gov NCT00877643.
KW - Aged
KW - Angiotensin-Converting Enzyme Inhibitors/therapeutic use
KW - Atrial Fibrillation/drug therapy
KW - Counseling
KW - Exercise Therapy
KW - Female
KW - Healthy Diet
KW - Heart Failure/complications
KW - Humans
KW - Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
KW - Male
KW - Middle Aged
KW - Mineralocorticoid Receptor Antagonists/therapeutic use
KW - Risk Reduction Behavior
KW - Rhythm control
KW - Atrial fibrillation
KW - Underlying conditions
KW - Risk factor management
UR - http://www.scopus.com/inward/record.url?scp=85045371808&partnerID=8YFLogxK
U2 - 10.1093/eurheartj/ehx739
DO - 10.1093/eurheartj/ehx739
M3 - Article
C2 - 29401239
SN - 0195-668X
VL - 39
SP - 2987
EP - 2996
JO - European Heart Journal
JF - European Heart Journal
IS - 32
ER -