Early rhythm control boosts AFib outcomes for patients with obesity, diabetes
Early rhythm control (ERC) is still an effective treatment for atrial fibrillation (AFib) when patients also present with obesity or diabetes, according to a new analysis published in JAMA Cardiology.[1]
The international EAST-AFNET 4 clinical trial previously determined ERC—treatment with antiarrhythmic drugs, ablation or cardioversion—was associated with improved outcomes for AFib patients compared to usual care. For this secondary analysis, however, researchers wanted to confirm this was still appropriate for two different subcategories of high-risk patients
“The effect of ERC therapy is independent of AFib-related symptoms and mediated by sinus rhythm,” wrote first author Andreas Metzner, MD, a cardiologist with University Heart and Vascular Center in Germany, and colleagues. “Whether this effectiveness is retained in patients with obesity and in those with diabetes is not known.”
The group tracked EAST-AFNET 4 data from more than 1,000 patients who were obese and nearly 1,700 patients who were not obese. In addition, they reviewed data from nearly 700 patients with diabetes and more than 2,000 patients without diabetes. All patients presented with AFib, and the mean age was 70 years old. Approximately 53% of patients were men.
Overall, presenting with obesity or diabetes did not impact the effectiveness of ERC, confirming that early treatments are an appropriate strategy for these patients.
“When this analysis was planned, a high risk of recurrent AFib was expected in patients with obesity with AFib,” the authors wrote. “Similarly, a higher risk of recurrent AFib and a higher risk of rhythm control–associated adverse events was expected in patients with diabetes. This knowledge, based on mechanistic, translational, and observational clinical data, led to the expectation of futility of ERC. To the contrary, this analysis showed that ERC is similarly effective and safe in patients with diabetes and in patients with obesity compared to patients without diabetes and without obesity with AFib. Put simply, neither obesity nor diabetes should be a reason to withhold ERC therapy in patients with AFib.”
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.