Patients with chronic kidney disease (CKD) and atrial fibrillation (AF) face elevated risks of stroke, heart failure, and cardiovascular complications. A predefined secondary analysis of the EAST-AFNET 4 trial published in the Journal of the American College of Cardiology evaluated the efficacy and safety of ERC according to kidney function status.
The EAST-AFNET 4 trial randomized patients with recently diagnosed AF and cardiovascular comorbidities to ERC or usual care (UC). The primary efficacy endpoint combined cardiovascular death, stroke, hospitalization for worsening heart failure, or acute coronary syndrome. Safety outcomes included death, stroke, and serious rhythm control-related adverse events.
Findings
- Patients with CKD were older than those without CKD: 74 ± 7.4 years vs 69 ± 8.3 years (P<0.001).
- CHA2DS2-VASc scores were higher in patients with CKD: 4.0 ± 1.4 vs 3.2 ± 1.2 (P<0.001).
- Lower GFR was associated with higher rates of primary outcome events over 5.1 years of follow-up: HR 0.98 per mL GFR decrease (95% CI 0.97–0.99).
- Among patients without CKD, ERC reduced the primary outcome compared with UC: 3.4 vs 4.1 events per 100 patient-years (HR 0.84; P<0.001).
- Among patients with CKD, ERC was also associated with lower primary outcome rates: 5.8 vs 8.5 events per 100 patient-years (HR 0.67; P<0.001).
- There was no significant interaction between CKD status and ERC treatment effect for the primary outcome (Pinteraction=0.133).
- CKD was associated with higher safety event rates overall, but without significant interaction with ERC (Pinteraction=0.927).
- Patients with CKD experienced more AF recurrences under usual care than those managed with ERC (Pinteraction=0.036).
In this secondary analysis of EAST-AFNET 4, early rhythm control was associated with reduced cardiovascular events in patients with recently diagnosed atrial fibrillation regardless of CKD status.
