Abstract 9516: Comparison of Mortality Rates Among Rate Control Agents in Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis

Abstract

Introduction: Rate control strategy is an effective treatment strategy for patients with atrial fibrillation (AF). However, data supporting the selection of rate-control medications is still lacking. We conducted a systematic review and meta-analysis to evaluate and compare mortality rate among beta-blocker (BB), calcium channel blocker (CCB), and digoxin for patients with AF undergoing rate control strategy. Methods: We searched MEDLINE, and EMBASE databases from inception to May 2021 to identify studies that compared all-cause mortality among patients who received single rate-control medication (BB, CCB, or digoxin). Data from each study were combined using the random-effects model to calculate pooled relative risk (RR) with 95% confidence interval (CI). Results: Five studies (2 randomized control trial and 3 retrospective cohort studies) with a total of 105,129 patients (45,910, 19,241, and 39,978 patients were in BB, CCB, and digoxin groups respectively) were included. Patients in digoxin group had higher mortality rates when compared to the BB group (pooled RR=0.55, 95%CI 0.5-0.61, p=<0.001) and the CCB group (pooled RR=0.73, 95%CI 0.56-0.95, p=0.018). There was a trend favoring BB when comparing BB to CCB, but failed to reach statistical significance (pooled RR=0.76, 95%CI 0.57-1, p=0.052). Conclusions: Our meta-analysis showed that rate control strategy in AF patients with digoxin was associated with higher mortality rates, but there was no statistical difference of the survival outcome between BB and CCB.