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A randomised, controlled study of rate versus rhythm control in patients with chronic atrial fibrillation and heart failure: (CAFE-II Study).
Heart. 2009 Jun; 95(11):924-30.H

Abstract

BACKGROUND

Atrial fibrillation (AF) and heart failure (HF) often coexist. The aim was to investigate whether restoring sinus rhythm (SR) could improve cardiac function, symptoms, exercise capacity and quality of life (QoL) in patients with chronic heart failure.

METHODS

Patients with HF and persistent AF receiving guideline-recommended treatments, including anticoagulants, were eligible for the study. Patients were randomised to either rhythm (treated with amiodarone for at least 3 months prior to attempting biphasic external cardioversion and continued amiodarone long-term if SR was restored) or rate control. Anticoagulants were continued throughout the study regardless of rhythm, unless contraindications developed. Both groups were treated with beta blockers and/or digoxin to reduce the heart rate to <80 bpm at rest and <110 bpm after walking. Symptoms, walk distance (6-minute corridor walk test, 6MWT), QoL and cardiac function were assessed at baseline and 1 year.

RESULTS

61 patients with HF and persistent AF (median duration 14 months (IQR 5 to 32)) were randomly assigned to a rate or rhythm control strategy. Of patients assigned to rhythm control (n = 30), 66% were in SR at 1 year, and 90% of those assigned to rate control (n = 31) achieved the heart rate target. At 1 year, NYHA class (p = 0.424) and 6MWT distance (p = 0.342) were similar between groups but patients assigned to rhythm control had improved LV function (p = 0.014), NT-proBNP concentration (p = 0.046) and QoL (p = 0.019) compared with those assigned to rate control. Greatest improvement was seen in patients in whom SR was maintained.

CONCLUSION

Restoring SR in patients with AF and heart failure may improve QoL and LV function when compared with a strategy of rate control.

Authors+Show Affiliations

Department of Cardiology, Castle Hill Hospital, Kingston-upon-Hull, UK. rhidianshelton@btinternet.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

19282313

Citation

Shelton, R J., et al. "A Randomised, Controlled Study of Rate Versus Rhythm Control in Patients With Chronic Atrial Fibrillation and Heart Failure: (CAFE-II Study)." Heart (British Cardiac Society), vol. 95, no. 11, 2009, pp. 924-30.
Shelton RJ, Clark AL, Goode K, et al. A randomised, controlled study of rate versus rhythm control in patients with chronic atrial fibrillation and heart failure: (CAFE-II Study). Heart. 2009;95(11):924-30.
Shelton, R. J., Clark, A. L., Goode, K., Rigby, A. S., Houghton, T., Kaye, G. C., & Cleland, J. G. (2009). A randomised, controlled study of rate versus rhythm control in patients with chronic atrial fibrillation and heart failure: (CAFE-II Study). Heart (British Cardiac Society), 95(11), 924-30. https://doi.org/10.1136/hrt.2008.158931
Shelton RJ, et al. A Randomised, Controlled Study of Rate Versus Rhythm Control in Patients With Chronic Atrial Fibrillation and Heart Failure: (CAFE-II Study). Heart. 2009;95(11):924-30. PubMed PMID: 19282313.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A randomised, controlled study of rate versus rhythm control in patients with chronic atrial fibrillation and heart failure: (CAFE-II Study). AU - Shelton,R J, AU - Clark,A L, AU - Goode,K, AU - Rigby,A S, AU - Houghton,T, AU - Kaye,G C, AU - Cleland,J G F, Y1 - 2009/03/11/ PY - 2009/3/14/entrez PY - 2009/3/14/pubmed PY - 2009/6/18/medline SP - 924 EP - 30 JF - Heart (British Cardiac Society) JO - Heart VL - 95 IS - 11 N2 - BACKGROUND: Atrial fibrillation (AF) and heart failure (HF) often coexist. The aim was to investigate whether restoring sinus rhythm (SR) could improve cardiac function, symptoms, exercise capacity and quality of life (QoL) in patients with chronic heart failure. METHODS: Patients with HF and persistent AF receiving guideline-recommended treatments, including anticoagulants, were eligible for the study. Patients were randomised to either rhythm (treated with amiodarone for at least 3 months prior to attempting biphasic external cardioversion and continued amiodarone long-term if SR was restored) or rate control. Anticoagulants were continued throughout the study regardless of rhythm, unless contraindications developed. Both groups were treated with beta blockers and/or digoxin to reduce the heart rate to <80 bpm at rest and <110 bpm after walking. Symptoms, walk distance (6-minute corridor walk test, 6MWT), QoL and cardiac function were assessed at baseline and 1 year. RESULTS: 61 patients with HF and persistent AF (median duration 14 months (IQR 5 to 32)) were randomly assigned to a rate or rhythm control strategy. Of patients assigned to rhythm control (n = 30), 66% were in SR at 1 year, and 90% of those assigned to rate control (n = 31) achieved the heart rate target. At 1 year, NYHA class (p = 0.424) and 6MWT distance (p = 0.342) were similar between groups but patients assigned to rhythm control had improved LV function (p = 0.014), NT-proBNP concentration (p = 0.046) and QoL (p = 0.019) compared with those assigned to rate control. Greatest improvement was seen in patients in whom SR was maintained. CONCLUSION: Restoring SR in patients with AF and heart failure may improve QoL and LV function when compared with a strategy of rate control. SN - 1468-201X UR - https://www.unboundmedicine.com/medline/citation/19282313/A_randomised_controlled_study_of_rate_versus_rhythm_control_in_patients_with_chronic_atrial_fibrillation_and_heart_failure:__CAFE_II_Study__ L2 - https://heart.bmj.com/lookup/pmidlookup?view=long&amp;pmid=19282313 DB - PRIME DP - Unbound Medicine ER -