Targeted therapy of underlying conditions improves quality of life in patients with persistent atrial fibrillation: results of the RACE 3 study

Ruben R. De With; Michiet Rienstra; Marcelle D. Smit; Bob Weijs; Victor W. Zwartkruis; Anne H. Hobbelt; Marco Atings; Jan G. P. Tijssen; Johan Brugemann; Bastiaan Geelhoed; Hans L. Hillege; Raymond Tukkie; Martin E. Hemels; Robert G. Tieleman; Adetita Ranchor; Dirk J. Van Veldhuisen; Harry J. G. M. Crijns; Isabelle C. Van Gelder; RACE 3 Investigators

doi:10.1093/europace/euy311

Targeted therapy of underlying conditions improves quality of life in patients with persistent atrial fibrillation: results of the RACE 3 study

Ruben R. De With, Michiet Rienstra, Marcelle D. Smit, Bob Weijs, Victor W. Zwartkruis, Anne H. Hobbelt, Marco Atings, Jan G. P. Tijssen, Johan Brugemann, Bastiaan Geelhoed, Hans L. Hillege, Raymond Tukkie, Martin E. Hemels, Robert G. Tieleman, Adetita Ranchor, Dirk J. Van Veldhuisen, Harry J. G. M. Crijns, Isabelle C. Van Gelder^*, RACE 3 Investigators

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Aims Atrial fibrillation (AF) reduces quality of life (QoL). We aim to evaluate effects of targeted therapy of underlying conditions on QoL in patients with AF and heart failure (HF).

Methods and results The Routine versus Aggressive risk factor driven upstream rhythm Control for prevention of Early atrial fibrillation in heart failure (RACE 3) study randomized patients with early persistent AF and HF to targeted or conventional therapy. Both groups received guideline-driven treatment. The targeted group received four additional therapies: mineralocorticoid receptor antagonists; statins; angiotensin converting enzyme inhibitors and/or receptor blockers; and cardiac rehabilitation including physical activity, dietary restrictions, and counselling. Quality of life was analysed in 230 patients at baseline and 1 year with available Medical Outcomes Study Short-Form Health Survey (SF-36), University of Toronto AF Severity Scale (AFSS) questionnaires, and European Heart Rhythm Association (EHRA) class. Improvements in SF-36 subscales were larger in the targeted group for physical functioning (1219 vs. 622, P=0.007), physical role limitations (32 +/- 41 vs. 17 +/- 45, P=0.018), and general health (8 +/- 16 vs. 0 +/- 17, P

Conclusion A strategy aiming to treat underlying conditions improved QoL more compared with conventional therapy in patients with early persistent AF and HF. Its benefit was even observed in patients in AF at 1 year.

Trial registration number Clinicaltrials.gov NCT00877643.

Original language	English
Pages (from-to)	563-571
Number of pages	9
Journal	EP Europace
Volume	21
Issue number	4
DOIs	https://doi.org/10.1093/europace/euy311
Publication status	Published - Apr 2019

Keywords

Atrial fibrillation
Quality of life
Risk factor
Targeted therapy
Randomized clinical trial
RHYTHM CONTROL
TRIAL
MANAGEMENT

Access to Document

10.1093/europace/euy311

Cite this

De With, R. R., Rienstra, M., Smit, M. D., Weijs, B., Zwartkruis, V. W., Hobbelt, A. H., Atings, M., Tijssen, J. G. P., Brugemann, J., Geelhoed, B., Hillege, H. L., Tukkie, R., Hemels, M. E., Tieleman, R. G., Ranchor, A., Van Veldhuisen, D. J., Crijns, H. J. G. M., Van Gelder, I. C., & RACE 3 Investigators (2019). Targeted therapy of underlying conditions improves quality of life in patients with persistent atrial fibrillation: results of the RACE 3 study. EP Europace, 21(4), 563-571. https://doi.org/10.1093/europace/euy311

@article{507bca94049f4dc582fb3c59c590fe62,

title = "Targeted therapy of underlying conditions improves quality of life in patients with persistent atrial fibrillation: results of the RACE 3 study",

abstract = "Aims Atrial fibrillation (AF) reduces quality of life (QoL). We aim to evaluate effects of targeted therapy of underlying conditions on QoL in patients with AF and heart failure (HF).Methods and results The Routine versus Aggressive risk factor driven upstream rhythm Control for prevention of Early atrial fibrillation in heart failure (RACE 3) study randomized patients with early persistent AF and HF to targeted or conventional therapy. Both groups received guideline-driven treatment. The targeted group received four additional therapies: mineralocorticoid receptor antagonists; statins; angiotensin converting enzyme inhibitors and/or receptor blockers; and cardiac rehabilitation including physical activity, dietary restrictions, and counselling. Quality of life was analysed in 230 patients at baseline and 1 year with available Medical Outcomes Study Short-Form Health Survey (SF-36), University of Toronto AF Severity Scale (AFSS) questionnaires, and European Heart Rhythm Association (EHRA) class. Improvements in SF-36 subscales were larger in the targeted group for physical functioning (1219 vs. 622, P=0.007), physical role limitations (32 +/- 41 vs. 17 +/- 45, P=0.018), and general health (8 +/- 16 vs. 0 +/- 17, PConclusion A strategy aiming to treat underlying conditions improved QoL more compared with conventional therapy in patients with early persistent AF and HF. Its benefit was even observed in patients in AF at 1 year.Trial registration number Clinicaltrials.gov NCT00877643.",

keywords = "Atrial fibrillation, Quality of life, Risk factor, Targeted therapy, Randomized clinical trial, RHYTHM CONTROL, TRIAL, MANAGEMENT",

author = "{De With}, {Ruben R.} and Michiet Rienstra and Smit, {Marcelle D.} and Bob Weijs and Zwartkruis, {Victor W.} and Hobbelt, {Anne H.} and Marco Atings and Tijssen, {Jan G. P.} and Johan Brugemann and Bastiaan Geelhoed and Hillege, {Hans L.} and Raymond Tukkie and Hemels, {Martin E.} and Tieleman, {Robert G.} and Adetita Ranchor and {Van Veldhuisen}, {Dirk J.} and Crijns, {Harry J. G. M.} and {Van Gelder}, {Isabelle C.} and {RACE 3 Investigators}",

note = "Funding Information: Conflict of interest: M.A. reports personal fees from Bayer, Boehringer-Ingelheim, Daiichi-Sankyo, Bristol-Myers-Squibb, Pfizer, and Sanofi. R.G.T. reports grants and personal fees from Bayer, Bristol-Myers-Squibb, Pfizer, and Daiichi-Sankyo. All other authors have no competing interests. Funding Information: This work was supported by the Netherlands Heart Foundation [grant 2008B035]. Unrestricted grants from AstraZeneca, Bayer, Biotronik, Boehringer-Ingelheim, Boston Scientific, Medtronic, Sanofi-Aventis, and St Jude Medical paid to the Netherlands Heart Institute. Publisher Copyright: {\textcopyright} 2019 The Author(s).",

year = "2019",

month = apr,

doi = "10.1093/europace/euy311",

language = "English",

volume = "21",

pages = "563--571",

journal = "EP Europace",

issn = "1099-5129",

publisher = "Oxford University Press",

number = "4",

}

De With, RR, Rienstra, M, Smit, MD, Weijs, B, Zwartkruis, VW, Hobbelt, AH, Atings, M, Tijssen, JGP, Brugemann, J, Geelhoed, B, Hillege, HL, Tukkie, R, Hemels, ME, Tieleman, RG, Ranchor, A, Van Veldhuisen, DJ, Crijns, HJGM, Van Gelder, IC & RACE 3 Investigators 2019, 'Targeted therapy of underlying conditions improves quality of life in patients with persistent atrial fibrillation: results of the RACE 3 study', EP Europace, vol. 21, no. 4, pp. 563-571. https://doi.org/10.1093/europace/euy311

TY - JOUR

T1 - Targeted therapy of underlying conditions improves quality of life in patients with persistent atrial fibrillation

T2 - results of the RACE 3 study

AU - De With, Ruben R.

AU - Rienstra, Michiet

AU - Smit, Marcelle D.

AU - Weijs, Bob

AU - Zwartkruis, Victor W.

AU - Hobbelt, Anne H.

AU - Atings, Marco

AU - Tijssen, Jan G. P.

AU - Brugemann, Johan

AU - Geelhoed, Bastiaan

AU - Hillege, Hans L.

AU - Tukkie, Raymond

AU - Hemels, Martin E.

AU - Tieleman, Robert G.

AU - Ranchor, Adetita

AU - Van Veldhuisen, Dirk J.

AU - Crijns, Harry J. G. M.

AU - Van Gelder, Isabelle C.

AU - RACE 3 Investigators

N1 - Funding Information: Conflict of interest: M.A. reports personal fees from Bayer, Boehringer-Ingelheim, Daiichi-Sankyo, Bristol-Myers-Squibb, Pfizer, and Sanofi. R.G.T. reports grants and personal fees from Bayer, Bristol-Myers-Squibb, Pfizer, and Daiichi-Sankyo. All other authors have no competing interests. Funding Information: This work was supported by the Netherlands Heart Foundation [grant 2008B035]. Unrestricted grants from AstraZeneca, Bayer, Biotronik, Boehringer-Ingelheim, Boston Scientific, Medtronic, Sanofi-Aventis, and St Jude Medical paid to the Netherlands Heart Institute. Publisher Copyright: © 2019 The Author(s).

PY - 2019/4

Y1 - 2019/4

N2 - Aims Atrial fibrillation (AF) reduces quality of life (QoL). We aim to evaluate effects of targeted therapy of underlying conditions on QoL in patients with AF and heart failure (HF).Methods and results The Routine versus Aggressive risk factor driven upstream rhythm Control for prevention of Early atrial fibrillation in heart failure (RACE 3) study randomized patients with early persistent AF and HF to targeted or conventional therapy. Both groups received guideline-driven treatment. The targeted group received four additional therapies: mineralocorticoid receptor antagonists; statins; angiotensin converting enzyme inhibitors and/or receptor blockers; and cardiac rehabilitation including physical activity, dietary restrictions, and counselling. Quality of life was analysed in 230 patients at baseline and 1 year with available Medical Outcomes Study Short-Form Health Survey (SF-36), University of Toronto AF Severity Scale (AFSS) questionnaires, and European Heart Rhythm Association (EHRA) class. Improvements in SF-36 subscales were larger in the targeted group for physical functioning (1219 vs. 622, P=0.007), physical role limitations (32 +/- 41 vs. 17 +/- 45, P=0.018), and general health (8 +/- 16 vs. 0 +/- 17, PConclusion A strategy aiming to treat underlying conditions improved QoL more compared with conventional therapy in patients with early persistent AF and HF. Its benefit was even observed in patients in AF at 1 year.Trial registration number Clinicaltrials.gov NCT00877643.

AB - Aims Atrial fibrillation (AF) reduces quality of life (QoL). We aim to evaluate effects of targeted therapy of underlying conditions on QoL in patients with AF and heart failure (HF).Methods and results The Routine versus Aggressive risk factor driven upstream rhythm Control for prevention of Early atrial fibrillation in heart failure (RACE 3) study randomized patients with early persistent AF and HF to targeted or conventional therapy. Both groups received guideline-driven treatment. The targeted group received four additional therapies: mineralocorticoid receptor antagonists; statins; angiotensin converting enzyme inhibitors and/or receptor blockers; and cardiac rehabilitation including physical activity, dietary restrictions, and counselling. Quality of life was analysed in 230 patients at baseline and 1 year with available Medical Outcomes Study Short-Form Health Survey (SF-36), University of Toronto AF Severity Scale (AFSS) questionnaires, and European Heart Rhythm Association (EHRA) class. Improvements in SF-36 subscales were larger in the targeted group for physical functioning (1219 vs. 622, P=0.007), physical role limitations (32 +/- 41 vs. 17 +/- 45, P=0.018), and general health (8 +/- 16 vs. 0 +/- 17, PConclusion A strategy aiming to treat underlying conditions improved QoL more compared with conventional therapy in patients with early persistent AF and HF. Its benefit was even observed in patients in AF at 1 year.Trial registration number Clinicaltrials.gov NCT00877643.

KW - Atrial fibrillation

KW - Quality of life

KW - Risk factor

KW - Targeted therapy

KW - Randomized clinical trial

KW - RHYTHM CONTROL

KW - TRIAL

KW - MANAGEMENT

U2 - 10.1093/europace/euy311

DO - 10.1093/europace/euy311

M3 - Article

C2 - 30629160

SN - 1099-5129

VL - 21

SP - 563

EP - 571

JO - EP Europace

JF - EP Europace

IS - 4

ER -