The Montreal Heart Institute presents the findings of an international research project on congestive heart failure and atrial fibrillation



    Simpler approach to atrial fibrillation treatment in heart failure
    patients eliminates need for repeated cardioversions and reduces
    hospitalization rates

    MONTREAL, June 18 /CNW Telbec/ - The results of a major international
clinical trial coordinated by the Montreal Heart Institute were reported today
in the New England Journal of Medicine. The Atrial Fibrillation and Congestive
Heart Failure Trial (AF-CHF) was a prospective, multicentre project involving
patients with heart failure and atrial fibrillation. Heart failure is an
important cause of death in the population and associated atrial fibrillation
(a very common heart rhythm disorder) further increases the risks. The trial
was launched in 2001 and enrolled 1,376 patients at 123 hospital sites in
North America, South America, Europe and Israel. The project's goal was to
improve treatment with the objective of reducing mortality and morbidity
linked with atrial fibrillation and heart failure. Made possible by a grant of
more than $6.5 million from the Canadian Institutes of Health Research (CIHR),
this study was directed by Dr. Denis Roy, a cardiologist at the Montreal Heart
Institute (MHI) and Chair of the Department of Medicine at the Université de
Montréal, in collaboration with Dr. Mario Talajic, also a cardiologist at the
MHI, and several Canadian researchers and international experts who
contributed to this large-scale research project.

    Methodology

    Between May 2001 and June 2005, the 1,376 patients were randomly assigned
to a rhythm-control strategy (where patients received electrical shocks and
medication to suppress the abnormal rhythm) or a more simpler strategy of
rate-control (where two common drugs, beta-blockers and digitalis, are used to
prevent rapid heart rates with no specific efforts to regularize the rhythm).
The primary endpoint of the study was cardiovascular mortality. Data
management and analysis were performed at the Montreal Heart Institute
Coordinating Center (MHICC).

    Rate-control as effective as rhythm-control

    The intention-to-treat analysis revealed no difference in the primary
endpoint between the two groups. Cardiovascular death occurred in 182 (27%)
patients in the rhythm-control group compared with 175 (25%) in the
rate-control arm. Total mortality, worsening heart failure and stroke were
similar between the two groups. Hospitalizations were more frequent in the
rhythm-control group, many due to hospitalization for management of atrial
fibrillation.

    Rate-control should be the primary approach

    The AF-CHF trial provides important new information concerning two
widely-used treatment strategies for atrial fibrillation in patients with
heart failure. The routine use of a rhythm-control strategy did not reduce the
rate of death in comparison with a rate-control strategy. Furthermore, there
were no significant differences in other important outcomes such as worsening
heart failure or stroke. The rate-control strategy eliminated the need for
repeated cardioversions and reduced rates of hospitalization. In conclusion,
the results of this trial suggest that rate-control, should be considered the
primary approach for patients with atrial fibrillation and congestive heart
failure.
    "It is now clear that the rate-control strategy offers a less complex
approach for the management of atrial fibrillation and could reduce rates of
hospitalization" says Dr. Denis Roy, the principal investigator.
    "The result of this provocative study challenges the conventional wisdom,
and shows that these patients can be conservatively managed, without repeated
electric shocks. This will serve as a new goal post for future care of these
patients," said Dr. Peter Liu, Scientific Director of the CIHR Institute of
Circulatory and Respiratory Health.

    About atrial fibrillation

    Atrial fibrillation is a cardiac rhythm disorder in which the upper
chamber of the heart (the atria) beats irregularly and very rapidly. Patients
may experience this in the form of palpitations, shortness of breath or chest
pain. This is the most common form of sustained arrhythmia. Contrary to
ventricular fibrillation (originating in the ventricles or lower chamber of
the heart), atrial fibrillation is rarely fatal but does require treatment as
it can lead to severe discomfort, heart failure or stroke. Atrial fibrillation
affects roughly 2.2 million Americans, predominantly the elderly.

    About congestive heart failure

    Congestive heart failure affects over 4 million Americans and the number
of patients suffering from heart failure will continue to rise over the next
few decades. Heart failure is a clinical syndrome where the heart is unable to
pump enough blood to satisfy the organism's metabolic needs. In roughly
two-thirds of cases, the dysfunction is caused by defective cardiac muscle
contraction due to coronary disease and hypertension. Despite recent advances
in our understanding of the physiopathology of heart failure and the
development of new drugs, the prognosis remains serious. The five-year
mortality rate is 50%, and heart failure is the main cause of cardiovascular
hospitalizations.

    About the Montreal Heart Institute

    Founded in 1954 by Dr. Paul David, the Montreal Heart Institute
constantly aims for the highest standards of excellence in the cardiovascular
field through its leadership in prevention, ultra-specialized care, training
of professionals, clinical and fundamental research, and assessment of new
technologies. It is affiliated with the Université de Montréal and its
clinical outcomes are among the best in the world.
    The MHI Research Centre officially came into existence in 1976 and has
made enormous strides since its creation. Today, there are approximately 500
employees, students and researchers at the MHI Research Centre. The MHI's
outstanding feature is the balance it achieves between basic research,
clinical research and clinical care. Its primary focus areas of research are
vascular diseases, myocardial function and cardiac electrophysiology. MHI
researchers also contribute to the advancement of knowledge and medical
applications in the fields of genomics (in particular in disease gene
discovery and pharmacogenomics), biomarkers and preventive cardiology. To
learn more about the Institute, please visit our website at www.icm-mhi.org.

    About the Université de Montréal

    Deeply rooted in Montreal and dedicated to its international mission, the
Université de Montréal is one of the top universities in the world,
particularly in the French-speaking world. Founded in 1878, the Université de
Montréal together with its two affiliated schools, HEC Montréal and Ecole
Polytechnique constitutes the largest centre of higher education and research
in Québec and the second largest in Canada. Advancing healthcare is a top
priority for the Université de Montréal, whose scientists are internationally
renowned for their practical and clinical investigations. In addition, the
University is Canada's sole institute of higher education to provide
instruction in every discipline related to health,

    About The Canadian Institutes of Health Research

    The Canadian Institutes of Health Research is the Government of Canada's
agency for health research. CIHR's mission is to create new scientific
knowledge and to catalyze its translation into improved health, more effective
health services and products, and a strengthened Canadian health-care system.
Composed of 13 Institutes, CIHR provides leadership and support to more than
11,000 health researchers and trainees across Canada.




For further information:

For further information: Doris Prince, Head, Communications and Public
Relations, Montreal Heart Institute, (514) 376-3330, Extension 3074,
doris.prince@icm-mhi.org; Valérie Gonzalo, (514) 626-6976,
gonzalo@videotron.ca

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