Analysis of Cause-Specific Mortality in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Study

Jonathan S. Steinberg, Ara Sadaniantz, Jack Kron, Andrew Krahn, D. Marty Denny, James Daubert, W. Barton Campbell, Edward Havranek, Katherine Murray, Brian Olshansky, Gearoid O'Neill, Magdi Sami, Stanley Schmidt, Randle Storm, Miguel Zabalgoitia, John Miller, Mary Chandler, Elaine M. Nasco, H. Leon Greene

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193 Scopus citations

Abstract

Background-Expectations that reestablishing and maintaining sinus rhythm in patients with atrial fibrillation might improve survival were disproved in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. This report describes the cause-specific modes of death in the AFFIRM treatment groups. Methods and Results-all deaths in patients enrolled in AFFIRM underwent blinded review by the AFFIRM Events Committee, and a mode of death was assigned. In AFFIRM, 2033 patients were randomized to a rhythm-control strategy and 2027 patients to a rate-control strategy. During a mean follow-up of 3.5 years, there were 356 deaths in the rhythm-control patients and 310 deaths in the rate-control patients (P=0.07). In the rhythm-control group, 129 patients (9%) died of a cardiac cause, and in the rate-control group, 130 patients (10%) died (P=0.95). Both groups had similar rates of arrhythmic and nonarrhythmic cardiac deaths. The numbers of vascular deaths were similar in the 2 groups: 35 (3%) in the rhythm-control group and 37 (3%) in the rate-control group (P=0.82). There were no differences in the rates of ischemic stroke and central nervous system hemorrhage. In the rhythm-control group, there were 169 noncardiovascular deaths (47.5% of the total number of deaths), whereas in the rate-control arm, there were 113 noncardiovascular deaths (36.5% of the total number of deaths) (P=0.0008). Differences in noncardiovascular death rates were due to pulmonary and cancer-related deaths. Conclusions-Management of atrial fibrillation with a rhythm-control strategy conferred no advantage over a rate-control strategy in cardiac or vascular mortality and may be associated with an increased noncardiovascular death rate.

Original languageEnglish (US)
Pages (from-to)1973-1980
Number of pages8
JournalCirculation
Volume109
Issue number16
DOIs
StatePublished - Apr 27 2004

Keywords

  • Antiarrhythmia agents
  • Atrium
  • Fibrillation
  • Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Steinberg, J. S., Sadaniantz, A., Kron, J., Krahn, A., Denny, D. M., Daubert, J., Campbell, W. B., Havranek, E., Murray, K., Olshansky, B., O'Neill, G., Sami, M., Schmidt, S., Storm, R., Zabalgoitia, M., Miller, J., Chandler, M., Nasco, E. M., & Greene, H. L. (2004). Analysis of Cause-Specific Mortality in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Study. Circulation, 109(16), 1973-1980. https://doi.org/10.1161/01.CIR.0000118472.77237.FA