Europace Advance Access originally published online on September 14, 2006
Europace 2006 8(11):935-942; doi:10.1093/europace/eul106
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ATRIAL FIBRILLATION
Does intensity of rate-control influence outcome in atrial fibrillation? An analysis of pooled data from the RACE and AFFIRM studies
1 Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands; 2 Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada; 3 Axio Research Corporation, Seattle, Washington; 4 Washington Hospital Center, Washington, DC, USA; 5 University of Iowa Hospital, Iowa City, IA, USA; 6 University Hospital, Maastricht, The Netherlands
Aims The AFFIRM and RACE studies showed that rate control is an acceptable treatment strategy for atrial fibrillation (AF). We examined whether strict rate control offers benefit over more lenient rate control.
Methods and Results We compared the outcome of patients enrolled in the rate-control arms of AFFIRM and RACE, using data from patients who met a composite of overlapping inclusion and exclusion criteria. We evaluated 1091 patients, 874 from AFFIRM and 217 from RACE. In AFFIRM, the rate-control strategy aimed for a resting heart rate 
80 bpm and heart rate during daily activity of 110 bpm. In RACE, a more lenient approach was taken: resting heart rate <100 bpm. Primary endpoint was a composite of mortality, cardiovascular hospitalization, and myocardial infarction. Mean heart rate across all follow-up visits for patients in AF was lower in AFFIRM (76.1 vs. 83.4 bpm). Event-free survival for the occurrence of the primary endpoint did not differ (64% in AFFIRM vs. 66% in RACE). Patients with mean heart rates during AF within the AFFIRM (80) or RACE (<100) criteria had a better outcome than patients with heart rates 
100 (hazard ratios 0.69 and 0.58, respectively, for 80 and <100 compared with 100 bpm).
Conclusion Stringency of the approach to rate control, based on the comparison of the AFFIRM and RACE studies, was not associated with an important difference in clinical events.
Key Words: Atrial fibrillation, Rate control, AFFIRM, RACE
* Corresponding author. Tel: +31 50 3612355; fax: +31 50 3614391. E-mail address: i.c.van.gelder{at}thorax.umcg.nl
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