Age and Outcomes of Early Rhythm Control in Patients With Atrial Fibrillation: Nationwide Cohort Study

Daehoon Kim, Pil Sung Yang, Seng Chan You, Eunsun Jang, Hee Tae Yu, Tae Hoon Kim, Hui Nam Pak, Moon Hyoung Lee, Gregory Y.H. Lip, Jung Hoon Sung, Boyoung Joung

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12 Citations (Scopus)


Objectives: This study sought to investigate whether the effects of early rhythm control differ according to age. Background: Rhythm control, compared with usual care among patients recently diagnosed with atrial fibrillation (AF), was found to be associated with a lower risk of adverse cardiovascular outcomes. It is unclear whether the results can be generalized for older adults. Methods: This retrospective population-based cohort study included 31,220 patients with AF, from the Korean National Health Insurance Service database, undergoing rhythm control (antiarrhythmic drugs or ablation) or rate control therapy, initiated within 1 year of AF diagnosis. A composite outcome of cardiovascular death, ischemic stroke, hospitalization for heart failure, or myocardial infarction was compared in subgroups stratified by age. Results: Compared with rate control, early rhythm control was associated with a lower risk of the primary composite outcome in patients <75 years of age (HR: 0.80; 95% CI: 0.72-0.88). The protective association between early rhythm control and cardiovascular outcomes exhibited a linear decrease with advancing age, with declined benefits in patients ≥75 years of age (HR: 0.94; 95% CI: 0.87-1.03; Pinteraction = 0.045). Trends toward lower risks of ischemic stroke (HR: 0.78; 95% CI: 0.67-0.90) and acute myocardial infarction (HR: 0.63; 95% CI: 0.41-0.97) were observed in the older adults. No significant differences in safety outcomes were found across different ages. Conclusions: The beneficial association of early rhythm control with cardiovascular outcomes was attenuated with increasing age, with the larger benefits in younger patients <75 years of age. No differences were found by age in treatment-related safety outcomes.

Original languageEnglish
Pages (from-to)619-632
Number of pages14
JournalJACC: Clinical Electrophysiology
Issue number5
Publication statusPublished - 2022 May

Bibliographical note

Funding Information:
The database used in this study was provided by the NHIS of Korea. The authors thank the NHIS for its cooperation.

Funding Information:
This research was supported by a grant from the Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health and Welfare, Republic of Korea (grants HI19C0481, HC19C0130, and HI15C1200). The funders of this study had no role in study design; collection, analysis, and interpretation of data; writing the report; and the decision to submit the report for publication. Dr Lip has served as a consultant for Bayer/Janssen, BMS/Pfizer, Biotronik, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi-Sankyo; and has served as a speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo; no fees have been received directly or personally. Dr Joung has served as a speaker for Bayer, BMS/Pfizer, Medtronic, and Daiichi-Sankyo; and has received research funds from Medtronic and Abbott; no fees have been received directly or personally. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Publisher Copyright:
© 2022 American College of Cardiology Foundation

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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