"Lenient vs Strict Rate Control in Patients with Atrial Fibrillation". The New England Journal of Medicine. 2010. 362:1363-1373. PubMed•Full
Links to original sources: Wiki Journal Post Full Journal Article
Contents 1 Clinical Question 2 Bottom Line 3 Major Points 4 Guidelines 5 Design 6 Population 6.1 Inclusion Criteria 6.2 Exclusion Criteria 6.3 Baseline Characteristics 7 Interventions 8 Outcomes 8.1 Primary Outcome 8.2 Secondary Outcomes 9 Criticisms 10 Funding 11 Further Reading
In patients with permanent atrial fibrillation, is lenient rate control inferior to strict rate control for preventing cardiovascular morbidity and mortality?
In patients with permanent atrial fibrillation, lenient rate control was not inferior to strict rate control for the prevention of cardiovascular morbidity and mortality and was easier to achieve.
The Rate Control Efficacy in Permanent Atrial Fibrillation: a Comparison between Lenient vs Strict Rate Control II (RACE II) study challenged the longstanding practice of strict rate control in atrial fibrillation. This study found that a lenient rate-control strategy (resting heart rate <110 beats per minute) was noninferior to a strict rate-control strategy (resting heart rate <80 beats per minute and heart rate during moderate exercise <110 beats per minute) regarding the prevention of cardiovascular events.
Current guidelines recommend a heart rate of <110 beats per minute in asymptomatic patients with permanent atrial fibrillation without the need for strict rate control unless the patient has symptoms.
Multicenter, randomized, open-label, noninferiority trial.
N=614 patients with permanent atrial fibrillation.
Inclusion Criteria Permanent atrial fibrillation up to 12 months, age ≤80 years, mean resting heart rate >80 beats per minute, and use of oral anticoagulation therapy.
Exclusion Criteria Disclosed previously by the study.
Baseline Characteristics Well matched, with a higher prevalence of coronary artery disease and statin use in the lenient-control group.
Randomly assigned to either lenient rate-control strategy (resting heart rate <110 beats per minute) or strict rate-control strategy (resting heart rate <80 beats per minute and heart rate during moderate exercise <110 beats per minute).
Primary Outcome Composite of death from cardiovascular causes, hospitalization for heart failure, and stroke, systemic embolism, bleeding, and life-threatening arrhythmic events: 12.9% in lenient-control group vs. 14.9% in strict-control group at 3 years (P<0.001 for noninferiority).
Similar frequencies of the components of the primary outcome between groups.
Study population may be considered low-risk, physically active patients, potentially limiting generalizability.
Supported by the Netherlands Heart Foundation, AstraZeneca, Biotronik, Boehringer Ingelheim, Boston Scientific, Medtronic, Roche, and Sanofi Aventis France.
The original publication and supplementary material can be accessed through The New England Journal of Medicine website.