AFFIRM

Question 1

AFFIRM Clinical Question

Answer 1

Among patients with atrial fibrillation and a high risk of stroke or death, what are the effects of rate control versus rhythm control on mortality?

Question 2

AFFIRM Bottom line

Answer 2

In patients with nonvalvular AF, there is no survival benefit between rate and rhythm control, but rhythm trends toward increased mortality.

Question 3

AFFIRM rate control options

Answer 3

ß-blocker, calcium channel blocker and/or digoxin

Question 4

AFFIRM design,

Answer 4

multi-center, parallel-group, randomized control trial, 4060 patients with non-valvular afib

Question 5

AFFIRM median follow up

Answer 5

3.5 years

Question 6

AFFIRM Primary outcome and analysis

Answer 6

All-cause mortality at 5 years, intention to treat

Question 7

AFFIRM inclusion criteria

Answer 7

• Age ≥65 years with AF that was likely to be recurrent
• AF likely to cause illness or death for the participant
• Long-term treatment of AF was warranted
• Other risk factors for stroke or death

Question 8

AFFIRM exclusion criteria

Answer 8

Contraindication to anticoagulation therapy

Ineligible to undergo trials of ≥2 medications in either treatment strategy

Question 9

AFFIRM Rate control strategy goals

Answer 9

Therapeutic target for heart rate at rest (<80 bpm) and during activity (<110 bpm), which usually consisted of six-minute walk

Question 10

AFFIRM Rhythm control strategy and meds

Answer 10

attempts to maintain sinus rhythm could include cardioversion as necessary.

class 1a(quinidine, procainamide, dispyrimidine) class,1c(flecainide, propafenone, moricizine), class 3(amidoerone, sotalol, dofetilide)

Question 11

5 year mortality numbers

Answer 11

25.9% vs. 26.7% (HR 1.15; 95% CI 0.99-1.34; P=0.08)

Question 12

which subgroups were associated with higher risk of death with rhythm control strategy

Answer 12

Older patients
Patients with CAD
Patients without HF

Question 13

AFFIRM Criticisms

Answer 13

Not generalizable to younger patients or to patients without risk factors for stroke (i.e. patients with primary, or “lone”, AF), particularly those with paroxysmal AF.

There were more but card would be too long