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Expert Consensus on Comprehensive Early Rhythm Control in Addition to Guideline-Based Care for Atrial Fibrillation: A Modified Delphi Survey - 03/11/23

Doi : 10.1016/j.amjcard.2023.08.004 
Thomas F. Deering, MD, MBA a, , Jonathan P. Piccini, MD, MHS b, Marlon Graf, PhD c, Jacquelyn W. Chou, MPP, MPL c, Rozanne Wilson, PhD d, Natalie Land, MPH c, David S. McKindley, PharmD, BCPS e, Charlotte M. Singh, MD, CMPP e, Carina Blomström-Lundqvist, MD, PhD f, g
a Piedmont Heart Institute, Atlanta, Georgia 
b Duke Clinical Research Institute, Durham, North Carolina 
c PRECISIONheor, Bethesda, Maryland 
d PRECISIONheor, Vancouver, British Columbia, Canada 
e Sanofi, Bridgewater, New Jersey 
f Department of Medical Science, Uppsala University, Uppsala, Sweden 
g Department of Cardiology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden 

Corresponding author: Tel: +1-404-605-2888.

Highlights

Atrial fibrillation guidelines recommend rate and rhythm-control strategies in symptomatic patients.
Atrial fibrillation guidelines recommend caution when using antiarrhythmic drugs.
Evidence is emerging on the role of early rhythm control.
Using early rhythm control was based on its improvement of cardiovascular outcomes.
Perceived efficacy and safety profiles were the most important in antiarrhythmic drug treatment selection.
Clinicians were inclined to adopt study results when making treatment decisions.

Il testo completo di questo articolo è disponibile in PDF.

Riassunto

Atrial fibrillation (AF) practice guidelines recommend a rhythm-control strategy to improve symptoms and quality of life, noting the side effects of antiarrhythmic drugs and catheter ablation. Emerging evidence indicates that comprehensive early rhythm control with antiarrhythmic drugs or catheter ablation is associated with a lower risk of adverse cardiovascular outcomes versus the usual care. Using an online modified Delphi survey approach, perspectives and expert consensus among electrophysiologists were examined through a series of ranking and likelihood questions around treatment decision-making on (1) the use of comprehensive early rhythm-control strategies in patients with AF based on guidelines and emerging research and (2) treatment selection factors. A panel of 17 electrophysiologists reached a consensus on using early rhythm control (median 90, interquartile range 14) based on the view that early intervention improved cardiovascular outcomes (mean rank 1.6 of 3, 82% within 1 SD) and symptoms (1.8 of 3, 41%). AF-related symptoms were identified as the most important in making a treatment initiation decision (1.1 of 7, 88%), followed by AF type (2.5 of 7, 82%). Participants were most likely to initiate treatment at AF symptom onset (median 80; interquartile range 6). In making treatment selection decisions, participants ranked short-term/long-term safety (1.9 of 7, 88%) and efficacy (1.8 of 7, 53%) as the top 2 considerations. In conclusion, experts were in favor of early rhythm control; however, additional research is needed to address the role that early rhythm-control strategies play in current AF treatment management algorithms.

Il testo completo di questo articolo è disponibile in PDF.

Keywords : atrial fibrillation, early rhythm control, treatment management, Delphi method


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 Funding: Financial support for this study was provided by Sanofi (Bridgewater, New Jersey).


© 2023  Pubblicato da Elsevier Masson SAS.
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P. 328-335 - novembre 2023 Ritorno al numero
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