The value of cardiovascular hospitalization as an endpoint for clinical atrial fibrillation research.

摘要: This editorial refers to ‘Cardiovascular hospitalization as a surrogate endpoint for mortality in studies of atrial fibrillation: report from the Stockholm Cohort Study Atrial Fibrillation’ by L. Friberg and M. Rosenqvist, on page 626. Cardiovascular (CV) has been used primary clinical fibrillation (AF), but its value remains controversial. is associated with decreased quality life, 1 increased costs care, 2 risk mortality. 3,4 However, it also composed multiplicity different conditions ranging heart failure angina, rates may vary among geographical regions settings. The operational definition CV an should be well understood draw valid conclusions AF research. Mortality relevant outcome assess effect therapies patients. because death are low existing effective, trials challenging conduct. From feasibility cost perspective useful employ combined endpoints, these validated. 5,6 potentially importance. Fibrillation Follow up Investigation Rhythm Management (AFFIRM) investigators have shown that could since occurs prior more often than true (mortality), can objectively measured, accurately predicted independent application rate or rhythm control. 3 first time was major trial ATHENA (A placebo controlled, double blind Trial efficacy dronedarone prevention cardiovascular Hospitalization any cause patiENts flutter) study, which study demonstrate reduction important outcomes antiarrhythmic drug (dronedarone). 7 With (SCAF) analysis, Rosenqvist 4 association between all-cause 2912 patients during 6.5-year follow-up using prospective observational cohort detailed patient information. SCAF analysis confirms original findings AFFIRM regarding significant strength did not differ greatly AFFIRM, although depends you look at. reported hazard ratio 2.15 control group 1.71 group. months following 1.69, 1.43 when taking into account deaths year even 1.35 propensity score correct unmeasured differences groups improve comparability this study. When adding medication use model final 2.5 years follow-up, ratios 12 were 2.08 1.63 respectively, compared favourably those observed AFFIRM. All analyses verified significance mortality, indicated importance nature association. Using new concept widely Although less disease-specific research, substitute seems justified considering two-fold mainly relates presence concomitant disease factors. 8 exact therefore needs some thought. showed primarily lower other diagnoses. Considering main driver hospitalization, 44% all hospitalizations, treatment specifically targeting might overall without significantly affecting In