Abstract
Introduction: Young adults with atrial fibrillation (AF) may be most vulnerable to adverse outcomes such as cardiac remodeling and stroke, due to exposeure to AF for a longer time over their life course. Research Question What are contemporary treatment patterns and outcomes for young adults with AF treated with rate or rhythm control strategies? Methods: We identified patients aged 21-60 years with incident AF diagnosed from 2010-2018 within a large, integrated healthcare system caring for >4.5M, and categorized them by treatment strategy within their first year after AF diagnosis: no treatment, rate control (AV nodal blockers only), or rhythm control (cardioversion, anti-arrhythmic drugs, or ablation). We examined crude outcomes of new onset heart failure (HF), stroke or transient ischemic attack (TIA), and use of oral anticoagulants (OAC), and examined multivariable associations between treatment strategy and outcomes using Cox regression. Results: Among 11,824 young adults with incident AF (mean [SD] age 51 [8.5] years; 32% female), 31% were treated with rhythm control, 50% with rate control, and 19% with no treatment. Those with no treatment were younger with fewer comorbidities. Crude rates (per 100 person-years) of incident HF and OAC were higher among rhythm control patients (HF: 4.45 for rhythm control, 2.51 for rate control, 0.56 for no treatment; OAC: 41.8 for rhythm control, 15.2 for rate control, 3.8 for no treatment), but rates of stroke/TIA were lower (0.71 for rhythm control, 0.92 for rate control, 0.51 for no treatment) (Figure). In adjusted analyses, no significant association was found for rhythm control (vs no rhythm treatment) for HF or stroke/TIA, but OAC use was higher (HR 1.66, 95%CI:1.57-1.70). Conclusions: Less than one third of young adults with AF received initial rhythm control therapy. Adverse outcomes were not associated with treatment strategy, but future studies should further examine long-term outcomes from sustained AF in young patients.
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