EAST-AFNET-4 analysis: early rhythm control cut events to 5.8 vs 8.5 per 100 patient-years in kidney disease

A secondary analysis of the EAST-AFNET-4 trial, published in the Journal of the American College of Cardiology and led by Schenker and colleagues, examined patients with recently diagnosed atrial fibrillation and chronic kidney disease, according to ad-hoc-news.de. The analysis included 2,742 patients with recently diagnosed atrial fibrillation and cardiovascular risk factors. Of these, 23 percent had chronic kidney disease, defined as an estimated glomerular filtration rate below 60 ml/min/1.73 m². ad-hoc-news.dead-hoc-news.dead-hoc-news.deOpen source ↗ The authors report that early rhythm control reduced the frequency of severe cardiovascular events in this high-risk group compared with usual care.

Endpoint and event rates

The median follow-up was 5.1 years. The combined primary endpoint consisted of cardiovascular death, stroke, and hospitalization for heart failure or acute coronary syndrome.

In patients with chronic kidney disease, the event rate was 5.8 per 100 patient-years under early rhythm control, compared with 8.5 per 100 patient-years under conventional standard care. This corresponds to a hazard ratio of 0.67 (p<0.001). In patients without kidney disease, the rates were 3.4 versus 4.1 events per 100 patient-years (hazard ratio 0.84; p<0.001). The interaction test gave p=0.133.

Patient profile and safety

Participants with chronic kidney disease were on average older than those with preserved kidney function: 74±7.4 years versus 69±8.3 years (p<0.001). ad-hoc-news.dead-hoc-news.dead-hoc-news.deOpen source ↗ Their mean CHA2DS2-VASc score was 4.0 versus 3.2, indicating a significantly higher risk of thromboembolic events (p<0.001).

For the predefined safety endpoints, the analysis found no adverse interaction between the treatment strategy and the presence of kidney dysfunction (p=0.927). According to the report, the results support early rhythm-maintaining intervention in patients with both cardiac and renal comorbidities.