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Impact of Early Rhythm Control and Healthy Lifestyles in AF Patients
Quick Takes
- In patients with new-onset AF, each early rhythm control and healthy lifestyle were associated with a significantly lower risk of ischemic stroke.
- Both additional early rhythm control alongside healthy lifestyle and additional healthy lifestyle alongside early rhythm control showed a cumulative risk reduction for ischemic stroke.
Study Questions:
What is the combined effect of early rhythm control (ERC) and healthy lifestyles (HLS) on the risk of ischemic stroke in patients with atrial fibrillation (AF)?
Methods:
The authors used the Korean National Health Insurance database to identify patients with new-onset AF who received rhythm control therapy within 2 years after AF diagnosis (ERC group). The database contains biannual self-reported questionnaires (only patients with lifestyle behavior data from a national health checkup within 2 years of AF diagnosis were included). The authors defined HLS behaviors as consisting of noncurrent smoking, abstaining from alcohol, and performing regular exercise. Patients with ≥2 HLS were defined as the HLS group. Patients were categorized into four groups: group 1 without ERC and HLS (n = ~47,000), group 2 with HLS alone (n = ~110,500), group 3 with ERC alone (n = ~15,000), and group 4 with both ERC and HLS (n = ~36,000). The primary outcome was ischemic stroke.
Results:
1) ERC alone was significantly associated with a 23% lower risk of ischemic stroke; 2) HLS alone was also associated with a lower risk of ischemic stroke by 23%; and 3) the combination of ERC and HLS showed the greatest risk reduction of ischemic stroke (by 42%).
Conclusions:
Each of ERC and HLS might reduce the risk of ischemic stroke in patients with new-onset AF. The presence of both ERC and HLS is associated with an enhanced benefit for stroke prevention in this population.
Perspective:
There is a growing body of evidence suggesting that ERC results in reduced risk of ischemic stroke. Adding aggressive modifiable risk factor management to AF catheter ablation improves the long-term success of sinus rhythm maintenance compared with that of AF catheter ablation alone. The authors in the current study, using nationwide health records of all South Koreans, showed that patients who receive both ERC and exhibit HLS experience the greatest reductions in ischemic stroke. This supports the current AF management guidelines, which emphasize holistic management of AF including a combination of anticoagulation, symptom control, and management of comorbidities and cardiovascular risk factors. A randomized clinical trial is needed to confirm the apparent synergistic benefit of ERC and HLS in patients with new-onset AF.
Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Atrial Fibrillation, Healthy Lifestyle
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