BACKGROUND:All patients with atrial fibrillation (AF) require optimization of their ventricular rate. Factors leading to use of additional rhythm control in clinical practice have not been thoroughly defined. METHODS:The ORBIT-AF registry enrolled patients with AF from a broad range of practice settings and collected data on rate versus rhythm control, as indicated by the treating physician. Multivariable logistic regression analysis was performed to identify factors associated with each strategy. RESULTS:Of 10,061 patients enrolled, 6,859 (68%) were managed with rate only control versus 3,202 (32%) with rhythm control. Patients managed with rate control were significantly older and more likely to have hypertension, heart failure, prior stroke, and gastrointestinal bleeds. They also had fewer AF-related symptoms (41% with no symptoms vs 31% for rhythm control). Systemic anticoagulation was prescribed for 5,448 (79%) rate-control patients versus 2,219 (69%) rhythm-control patients (P < .0001). After multivariable adjustment, patients with higher symptom scores (severe symptoms vs. none, OR 1.62, 95% CI 1.41-1.87) and those referred to electrophysiologists (OR 1.64, 95% CI 1.45-1.85) were more likely to be managed with a rhythm control strategy. CONCLUSIONS:In this outpatient registry of US clinical practice, the majority of patients with AF were managed with rate control alone. Patients with more symptoms and who were treated by an electrophysiologist were more likely to receive rhythm-control therapies. A significant proportion of AF patients, regardless of treatment strategy, were not treated with anticoagulation for thromboembolism prophylaxis.

译文

背景:所有房颤患者都需要优化心室率。尚未在临床实践中明确导致使用其他节律控制的因素。
方法:按照治疗医师的指示,ORBIT-AF登记系统从广泛的实践环境中招募了AF患者,并收集了其心率与心律控制的相关数据。进行多变量逻辑回归分析以识别与每种策略相关的因素。
结果:在10061名患者中,有6859名(68%)接受了单纯速率控制,而有3202名(32%)接受了节奏控制。进行速率控制的患者年龄较大,并且更有可能患有高血压,心力衰竭,中风和胃肠道出血。他们也有较少的房颤相关症状(41%无症状,节律控制为31%)。相对于2,219(69%)节律患者,对5448(79%)个速率控制的患者进行了全身抗凝治疗(P <.0001)。经过多变量调整后,症状评分较高(严重症状对比无症状,OR 1.62,95%CI 1.41-1.87)和转诊给电生理学家的患者(OR 1.64,95%CI 1.45-1.85)更容易接受节奏控制策略。
结论:在这个美国临床实践的门诊登记中,大多数房颤患者仅通过速率控制进行治疗。症状更多且由电生理师治疗的患者更有可能接受节律控制疗法。不论采用何种治疗策略,相当大比例的房颤患者均未接受抗凝治疗以预防血栓栓塞。

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