P2294Four targeted therapies and less than four targeted therapies of underlying conditions against conventional therapy in atrial fibrillation - data from the RACE 3 study

Abstract

Introduction: Atrial fibrillation (AF) is a progressive disease. Many risk factors have been described for AF. Purpose(s): We sought to explore the outcome between all 4 targeted therapies of underlying conditions, less than 4 targeted therapies and conventional therapy in patients with early persistent AF and early mild to moderate heart failure (HF). Method(s): We analyzed outcome in patients from the prospective, randomized, multicenter Routine vs. Aggressive risk factor driven upstream rhythm Control for prevention of Early atrial fibrillation in heart failure (RACE 3) study. The intervention group received 4 therapies on top of conventional care: 1) mineralocorticoid receptor antagonist, 2) angiotensin converting enzyme inhibitor, 3) statin, 4) cardiac rehabilitation including physical activity, dietary restrictions, and counseling. For this analysis, we evaluated how many patients of the intervention group completed all 4 targeted therapies and how many completed less than 4 therapies and what the difference in outcomes were. Of the 245 patients, 119 patients were randomized to targeted therapy and 126 patients to conventional therapy. In the targeted therapy group 69 of 119 patients completed all 4 targeted therapies, 49 completed less than 4 targeted therapies. One had missing data and was therefore excluded from further analyses. Result(s): Mean age was 65+/-9 years, 193 (79%) were men, median total AF history was 3 (2-6) months. 144 (59%) patients had hypertension, 26 (11%) diabetes and 33 (13%) coronary artery disease. Clinical characteristics were comparable between the 3 groups. Comparing the complete targeted therapies group to the conventional group, sinus rhythm was seen in 84% vs. 63% respectively (p=0.002). Sinus rhythm was seen in 84% of the complete targeted therapies group compared 63% to the <4 targeted therapies group (p=0.011). Weight, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure, NT-proBNP, total cholesterol and LDL-cholesterol were all significantly improved after 1-year follow up in the complete targeted therapies group com- pared to the conventional group (Figure). Weight, BMI, SBP and total cholesterol were also significantly improved in the complete targeted therapies group compared to the <4 completed targeted therapies group. No difference was seen in urine sodium and left atrial volume after 1-year between the 3 groups. Conclusion(s): Applying all 4 targeted therapies of underlying conditions of AF improves sinus rhythm maintenance and risk factors in patients with early persistent AF and HF.