Author + information
- Received April 10, 2012
- Revision received October 21, 2012
- Accepted October 30, 2012
- Published online January 29, 2013.
- Irina Suman-Horduna, MD, MSc⁎,
- Denis Roy, MD⁎,
- Nancy Frasure-Smith, PhD⁎,†,
- Mario Talajic, MD⁎,
- François Lespérance, MD†,
- Lucie Blondeau, MSc⁎,
- Paul Dorian, MD, MSc‡,
- Paul Khairy, MD, PhD⁎,⁎ (, )
- AF-CHF Trial Investigators
- ⁎Montreal Heart Institute and Montreal Heart Institute Coordinating Center, Université de Montréal, Montreal, Quebec, Canada
- †Department of Psychiatry, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- ‡Department of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- ↵⁎Reprint requests and correspondence:
Dr. Paul Khairy, Montreal Heart Institute, 5000 Belanger Street East, Montreal, Quebec H1T 1C8, Canada
Objectives This study sought to assess the impact of rhythm- versus rate-control treatment strategies and of underlying rhythm on quality of life and functional capacity in patients with atrial fibrillation (AF) and congestive heart failure (CHF).
Background Although intention-to-treat and efficacy analyses have demonstrated similar cardiovascular outcomes in patients with AF and CHF randomized to rhythm or rate control, effects on quality of life remain to be determined.
Methods The AF-CHF (Atrial Fibrillation and Congestive Heart Failure) trial randomized 1,376 patients to rhythm- or rate-control strategies. For this pre-specified substudy, Medical Outcomes Short Form-36 questionnaires were administered at baseline and 4 months. Six-min walk tests were conducted at baseline, 3 weeks, 4 months, and 1 year.
Results Quality of life improved across all domains to a similar extent with rhythm and rate control. However, a higher proportion of time spent in sinus rhythm was associated with a modestly greater improvement in quality of life scores. Six-min walk distance (p = 0.2328) and New York Heart Association functional class (p = 0.1712) improved to a similar degree with rhythm and rate control. A higher proportion of time spent in sinus rhythm was associated with a greater improvement in New York Heart Association functional class (p < 0.0001) but not in 6-min walk distance (p = 0.1308).
Conclusions Improvements in quality of life and functional capacity were similar in patients with AF and CHF randomized to rhythm- versus rate-control strategies. By contrast, sinus rhythm was associated with beneficial effects on New York Heart Association functional class and modest gains in quality of life. (Atrial Fibrillation and Congestive Heart Failure [AF-CHF]; NCT88597077)
The AF-CHF trial was funded by the Canadian Institutes of Health Research. Dr. Khairy is supported by a Canada Research Chair in Electrophysiology and Adult Congenital Heart Disease. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 10, 2012.
- Revision received October 21, 2012.
- Accepted October 30, 2012.
- 2013 American College of Cardiology Foundation