Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice and currently affects more than 2.2 million Americans. AF was designated as a new epidemic, and its public health impact is amplified by the aging population and increased survival after myocardial infarction and heart failure. Despite its major clinical and public health impact, contemporary data on the AF epidemic are scarce. In addition, the outcomes of AF are of major clinical consequence as AF confers a large excess risk of stroke and death. Treatment for AF includes strategies to control rate, correct rhythm disturbance, and prevent thromboembolism. The management of AF may affect the occurrence of stroke and survival, and the outcomes related to the choice of a rate control or rhythm control strategy have been evaluated in several randomized trials. In the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial, no survival difference was found between rate and rhythm control. However, in a meta-analysis pooling the AFFIRM trial with 4 other randomized trials, rate control compared to rhythm control was associated with a significantly lower risk of a combined endpoint of all-cause mortality and stroke. The clinical practice impact and implications of these data are not fully characterized: in particular, the effect of rate vs. rhythm control on adverse outcomes of AF should be evaluated in the community to understand the associations of AF treatment with survival and stroke-free survival. Our study proposes to use the resources of the Rochester Epidemiology Project (R01 AG034676) to evaluate in a community setting, by complete capture of disease occurrence and outcomes, the following: 1) to examine the trends in incidence of AF among adults in Olmsted County, MN between 1995 and 2010, and assemble a population-based incidence cohort of persons with AF under the auspices of the Rochester Epidemiology Project, 2) to characterize the trends in treatment approaches (rate and rhythm control) and adverse outcomes related to AF (stroke and death) among the incident AF cohort, and 3) to examine the outcomes of AF as they relate to management in a 'real-life' community cohort utilizing three analytical approaches for comparative effectiveness research: proportional hazards regression with time-dependent treatment, propensity scores, and marginal structural models.
|Program type||Scientist Development Grant|
|Effective start/end date||07/01/2011 → 06/30/2015|