Abstract：
Despite multiple trials comparing rate with rhythm control, there is no consensus on the optimal management of first-detected atrial fibrillation (AF).
We analyzed current patterns of care for first-detected AF in the nationwide Get With The Guidelines® - Atrial Fibrillation registry.
Patients hospitalized with first-detected AF from 2013 to 2019 were included, and a descriptive analysis was performed comparing planned rate with rhythm control. Multivariable logistic regression analysis was performed to identify predictors for choosing rhythm over rate control.
Of the 86,759 patients with AF, 17.8% (15,473) had first-detected AF; 11,685 patients were included from 126 sites. Overall, 51.3% (5999) of patients were treated with rate control and 48.7% (5686) with rhythm control at admission. Patients with planned rhythm control had a shorter length of stay and were more likely to be discharged home than a facility. A higher percentage of patients with planned rhythm control were discharged on anticoagulation than those with planned rate control (75.6% vs 70.9%) despite a higher underlying stroke risk in the rate control group (higher median CHA2DS2-VASc score 4; Q1-Q3 2-5 for rate control vs 3; Q1-Q3 2-4 for rhyhtm control; P < .001). While Hispanic ethnicity, Medicaid insurance, age >70 years, and liver disease decreased the likelihood of rhythm control, factors such as heart failure, stroke, or prior bleeding diathesis had no association with the chosen treatment strategy.
Less than half of the patients with first-detected AF receive rhythm control at admission. Given recent trial results, further studies should assess the long-term impact of rhythm control on patients\' symptoms and quality of life, cardiovascular morbidity, and mortality.
We analyzed current patterns of care for first-detected AF in the nationwide Get With The Guidelines® - Atrial Fibrillation registry.
Patients hospitalized with first-detected AF from 2013 to 2019 were included, and a descriptive analysis was performed comparing planned rate with rhythm control. Multivariable logistic regression analysis was performed to identify predictors for choosing rhythm over rate control.
Of the 86,759 patients with AF, 17.8% (15,473) had first-detected AF; 11,685 patients were included from 126 sites. Overall, 51.3% (5999) of patients were treated with rate control and 48.7% (5686) with rhythm control at admission. Patients with planned rhythm control had a shorter length of stay and were more likely to be discharged home than a facility. A higher percentage of patients with planned rhythm control were discharged on anticoagulation than those with planned rate control (75.6% vs 70.9%) despite a higher underlying stroke risk in the rate control group (higher median CHA2DS2-VASc score 4; Q1-Q3 2-5 for rate control vs 3; Q1-Q3 2-4 for rhyhtm control; P < .001). While Hispanic ethnicity, Medicaid insurance, age >70 years, and liver disease decreased the likelihood of rhythm control, factors such as heart failure, stroke, or prior bleeding diathesis had no association with the chosen treatment strategy.
Less than half of the patients with first-detected AF receive rhythm control at admission. Given recent trial results, further studies should assess the long-term impact of rhythm control on patients\' symptoms and quality of life, cardiovascular morbidity, and mortality.
摘要：
尽管有多项试验比较了心率和节律控制，对于首次检测到的心房颤动(AF)的最佳管理尚无共识.
我们分析了全国范围内首次检测到的房颤的当前护理模式。
包括2013年至2019年首次发现房颤住院的患者，并进行了描述性分析,比较了计划心率和节律控制.进行了多变量逻辑回归分析，以确定选择节律而不是速率控制的预测因子。
在86,759例房颤患者中,17.8%（15,473）首次检测到房颤；来自126个地点的11,685名患者被纳入。总的来说,51.3％（5999）的患者在入院时接受了速率控制，48.7％（5686）的患者接受了节律控制。与设施相比，计划节律控制的患者住院时间较短，并且更有可能出院。尽管心率对照组的潜在卒中风险较高，但计划节律控制的患者接受抗凝治疗的比例高于计划心率控制的患者（75.6％vs70.9％）（CHA2DS2-VASc评分中位数较高4；心率控制的Q1-Q32-5比3；心率控制的Q1-Q32-4；P<.001）。而西班牙裔种族，医疗补助保险,年龄>70岁，肝病降低了节律控制的可能性，心力衰竭等因素，中风,或既往出血素质与所选择的治疗策略无关.
不到一半的首次检出房颤患者在入院时接受心律控制。鉴于最近的试验结果,进一步的研究应评估节律控制对患者症状和生活质量的长期影响，心血管发病率，和死亡率。
我们分析了全国范围内首次检测到的房颤的当前护理模式。
包括2013年至2019年首次发现房颤住院的患者，并进行了描述性分析,比较了计划心率和节律控制.进行了多变量逻辑回归分析，以确定选择节律而不是速率控制的预测因子。
在86,759例房颤患者中,17.8%（15,473）首次检测到房颤；来自126个地点的11,685名患者被纳入。总的来说,51.3％（5999）的患者在入院时接受了速率控制，48.7％（5686）的患者接受了节律控制。与设施相比，计划节律控制的患者住院时间较短，并且更有可能出院。尽管心率对照组的潜在卒中风险较高，但计划节律控制的患者接受抗凝治疗的比例高于计划心率控制的患者（75.6％vs70.9％）（CHA2DS2-VASc评分中位数较高4；心率控制的Q1-Q32-5比3；心率控制的Q1-Q32-4；P<.001）。而西班牙裔种族，医疗补助保险,年龄>70岁，肝病降低了节律控制的可能性，心力衰竭等因素，中风,或既往出血素质与所选择的治疗策略无关.
不到一半的首次检出房颤患者在入院时接受心律控制。鉴于最近的试验结果,进一步的研究应评估节律控制对患者症状和生活质量的长期影响，心血管发病率，和死亡率。
