Intern Emerg Med. 2026 Mar 6. doi: 10.1007/s11739-026-04301-5. Online ahead of print.
ABSTRACT
In the era of non-vitamin K antagonist oral anticoagulants (NOACs), it remains unclear whether rate control versus rhythm control as an initial treatment strategy affects the prognosis of patients with new-onset atrial fibrillation (AF). This is a post hoc analysis of the prospective global GLORIA-AF registry aimed to compare the impact of rate control versus rhythm control as an initial treatment strategy on the prognosis in AF patients. The primary endpoint was a composite of all-cause mortality and thromboembolism during a 24 month follow-up. A total of 20,571 patients were included in this study, including 8391 with rhythm control and 12,180 with rate control as an initial treatment strategy. Compared with rate control strategy, rhythm control strategy was associated with decreased risk of the primary endpoint (HR = 0.96, 95% CI, 0.95, 0.97, p < 0.001). However, propensity score matching analysis showed the primary endpoint was comparable between patients received rate control versus those with rhythm control (HR = 0.97, 95% CI 0.92, 1.03, p = 0.3). Subgroup analysis revealed an interaction between the initial treatment strategy and both the patients' geographic region and the presence of concomitant chronic kidney disease. In the era of NOACs, a post hoc analysis of the GLORIA-AF study did not show a major impact of rate control compared to rhythm control as an initial treatment strategy on the composite endpoint of all-cause mortality and thromboembolism in patients with new-onset AF. In this post hoc analysis of the GLORIA-AF registry reflecting real-world clinical practice in the era of NOACs, no major difference was observed between rate control and rhythm control as initial treatment strategies with respect to the composite endpoint of all-cause mortality and thromboembolism in patients with new-onset AF. Our results provide complementary real-world evidence to existing randomized trials and highlight the complexity of treatment selection in routine practice, suggesting that a more individualized approach may be warranted and that further prospective studies are needed to better define which patients may benefit most from different management strategies.
PMID:41790410 | DOI:10.1007/s11739-026-04301-5