Background: There are limited data regarding the combined effect of early rhythm control (ERC) and healthy lifestyles (HLS) on the risk of ischemic stroke in patients with atrial fibrillation (AF).

Objectives: To evaluate how the combination of ERC and HLS impacts on the risk of ischemic stroke in patients with AF.

Methods: Using the Korean National Health Insurance database, we included patients with new-onset AF between 2009 and 2016 (n=208,662). Patients who received rhythm control therapy within 2-year after AF diagnosis were defined as the ERC group. Patients with ≥2 HLS were defined as the HLS group. Patients were categorized into 4 groups: group 1 without ERC and HLS (n=46,972), group 2 with HLS alone (n=110,479), group 3 with ERC alone (n=15,133) and group 4 with both ERC and HLS (n=36,078). The primary outcome was ischemic stroke.

Results: Compared to group 1, group 2 and group 3 were associated with a lower risk of stroke (HR, 95% confidence interval: 0.769, 0.728-0.881, and 0.774, 0.703-0.852, respectively). Group 4 showed the lowest risk of stroke (0.575, 0.536-0.617). After propensity score weighting, the incorporation of additional ERC alongside HLS was associated with a relative risk reduction of 22% for stroke, while additional HLS alongside ERC was associated with a relative risk reduction of 27% for stroke.

Conclusion: Each of ERC and HLS might reduce the risk of ischemic stroke in patients with new-onset AF. The presence of both ERC and HLS is associated with an enhanced benefit for stroke prevention in this population.

Editor-in-Chief
Kalyanam Shivkumar, MD, PhD, FACC
 
CME Editor
Kenneth A. Ellenbogen, MD, FACC

Author
Kelvin Bush, MD, FACC

Important Dates
Date of Release: June 24, 2024
Term of Approval/Date of CME/MOC Expiration: June 23, 2025