MO466: Impact of Renal Insufficiency on Choice of Rhythm or Rate Control in Atrial Fibrillation and Subsequent Effects on Cardiovascular and Mortality Outcomes

Abstract BACKGROUND AND AIMS Atrial fibrillation remains the most common sustained arrhythmia in the general population, with prevalence inversely correlated with renal function. Management of atrial fibrillation relies on either rhythm control or rate control, however, the choice of treatment in patients with impaired renal function remains contentious. Accordingly, we examined clinical practice and subsequent treatment outcomes. METHOD Based on nationwide healthcare registers, all patients with atrial fibrillation were identified in Denmark between 2000 and 2021. Patients aged < 18 years, and with previous prescriptions on amiodarone, digoxin, beta-blockers, calcium antagonists, or anti-coagulative medicine, or without a pre-existent record of creatinine level were excluded. Patients were stratified into two groups receiving either rhythm or rate control with the expulsion of patients with no treatment. Baseline renal function was calculated using the CKD-EPI equation based on recent plasma creatinine. The probability of rhythm control versus rate control stratified on estimated glomerular filtration rate (eGFR) (>90mL/min/1.73m2, 60–90 mL/min/1.73m2, 30–60 mL/min/1.73m2, 90 mL/min/1.73m2 . With rate control as reference, adjusted hazard ratios for subsequent cardiovascular outcomes were 1.51 (95% CI 1.40–1.62) for eGFR > 90 mL/min/1.73m2, 1.53 (1.45–1.62) for eGFR 60–90 mL/min/1.73m2, 1.86 (1.68–2.05) for eGFR 30–60 mL/min/1.73m2 and 1.88 (1.47–2.41) for eGFR < 30 mL/min/1.73 m2. Cumulative risks of cardiovascular outcomes are shown in Figure 1. Figure 1: Cumul