Early rhythm control reduces CV events in AF patients

Early rhythm control (ERC) is a safe and effective strategy to prevent cardiovascular (CV) events in patients with a recent diagnosis of atrial fibrillation and stroke risk factors with or without chronic kidney disease (CKD), according to a secondary analysis of the EAST-AFNET 4 trial.

EAST-AFNET 4 is a randomized trial of 2,789 patients recently diagnosed with AF and had comorbidities. Participants were randomly assigned to ERC or usual care (UC). Of the participants, 2,742 (98.3 percent) had available baseline creatinine data, and about one in four (23 percent) had CKD (GFR: <60 mL/min/1.73 m²).

Patients with CKD tended to be older (vs without CKD: 74 vs 69 years; p<0.001), have higher CHA₂DS₂-VASc scores (4 vs 3.2; p<0.001), and experience more primary outcome events (ie, combined CV death, stroke, hospitalization for worsening heart failure, or acute coronary syndrome) over 5.1 years of follow-up (hazard ratio [HR], 0.98 per mL GFR decrease, 95 percent confidence interval [CI], 0.97-0.99).

ERC reduced the primary outcome in patients with (ERC: 5.8 percent per 100 patient-years; UC: 8.5 percent per 100 patient-years; HR, 0.67; p<0.001) or without CKD (ERC: 3.4 percent per 100 patient-years; UC: 4.1 percent per 100 patient-years; HR, 0.84; p<0.001; p_interaction=0.133).

Notably, CKD led to higher safety outcomes without interaction with ERC (p_interaction=0.927). Patients with CKD who received usual care had more AF recurrence (p_interaction=0.036).

AF tends to elevate the risk of CV events in patients with CKD, according to the investigators.