![]() The design and methodology of the GWTG‐HF registry have been described previously. All participating centers obtain institutional review board approval for the registry protocol, and given that the primary purpose of the registry is for quality improvement, a waiver for informed consent is granted under the Common Rule. The primary data source for this study used the American Heart Association's GWTG‐HF registry, which is an ongoing hospital‐based voluntary national HF registry that was established in 2005. 8, 13, 14, 15, 16 To describe current treatment patterns and subsequent outcomes in patients with HFpEF complicated by AF, we analyzed the GWTG‐HF registry linked to Medicare claims data. As a result, the guideline writing committees limit their scope to treatment of associated comorbidities. 6, 12 Despite accumulating epidemiologic data detailing worse outcomes in patients with HFpEF complicated by AF, there are no medical therapies that have been definitively shown to improve outcomes for patients with HFpEF. HFpEF and AF have shared risk factors, confer increased risks for adverse cardiovascular outcomes, and frequently occur together. ![]() 10 Similar comparisons in the GWTG‐HF (Get With The Guidelines-Heart Failure) registry extends these prior findings, demonstrating that AF is common in patients with HF and associated with higher mortality, readmissions, and HF readmissions. ![]() 9 A recent meta‐analysis revealed that all‐cause mortality is significantly higher in patients with AF and HFrEF compared with patients with AF and HFpEF, yet stroke risk and HF hospitalization rates were similar among both groups. 8 The AF guidelines recommend rhythm control only in patients who remain symptomatic despite rate control treatment. There is no other specific recommendation for rate versus rhythm control in the HF guidelines. 8 Patients with newly diagnosed HF in the presence of AF with rapid ventricular response are recommended to undergo rhythm control, as a rate‐related cardiomyopathy is a reversible cause of HF. The guidelines then differentiate patients who develop HF as a result of AF and patients who have HF and go on to develop AF. 7 The HF guidelines focus their recommendations on prevention of thromboembolism and symptom control with the goal to correct underlying causes of AF and HF and optimize HF management. Patients with HF and AF have worse outcomes than patients with HF without AF. 3, 4, 5, 6 In patients with HFpEF, the prevalence of AF ranges from 15% to 41% in registries and clinical trials. 1, 2 Atrial fibrillation (AF) is the most common sustained arrhythmia in patients with HF, occurring in approximately one third of patients. Patients with HFpEF have similar risks of morbidity and all‐cause mortality as patients with heart failure with reduced ejection fraction (HFrEF). Heart failure with preserved ejection fraction (HFpEF) accounts for one half of all heart failure (HF) visits and hospital admissions in the United States. The lower 1‐year all‐cause death in the rhythm control group remained after risk adjustment (adjusted hazard ratio, 0.86 95% CI, 0.75–0.98 P=0.02). There was higher all‐cause death at 1 year in the rate control compared with the rhythm control group (37.5% and 30.8%, respectively, P<0.01). Among 15 682 fee‐for‐service Medicare patients, at the time of discharge, 1857 were treated with rhythm control and 13 825 with rate control, with minimal differences in baseline characteristics between groups. ![]() Rate control was defined as use of any combination of β‐blocker, calcium channel blocker, and digoxin without evidence of rhythm control. Rhythm control was defined as use of an antiarrhythmic medication, cardioversion, or AF ablation or surgery. We analyzed the Get With The Guidelines-Heart Failure (GWTG‐HF) registry linked to Medicare claims data from 2008 to 2014 to describe current treatments for rate versus rhythm control and subsequent outcomes in patients with heart failure with preserved ejection fraction and atrial fibrillation using inverse probability weighted analysis.
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