Rate-Control Tx for A-fib: Beta Blockers vs. Calcium Channel Blockers
the MPR take:
Evidence comparing the effectiveness of beta-blockers (BBs) and calcium channel blockers (CCBs) as first-line rate-control therapy for atrial fibrillation (AF) is limited, but a new study is the first to compare long-term persistent use of BBs and CCBs in non-elderly adults with AF. A total of 1,239 patients between the ages of 40–60 with first diagnosis of AF between July 1, 2006 and June 30, 2010 were studied for length of time that the patients remained on the rate-control medication (approximating effectiveness). Patients who started treatment on CCBs were nearly twice as likely to switch to a more aggressive treatment vs. those with initial BB therapy; greater rate control was achieved in 38% of patients treated with CCBs alone compared to 59% for those treated with BBs alone. While most people had no change in their initial rate-control therapy, a significantly greater portion of CCB patients switched to or added a BB during follow-up compared to the initial BB arm. Further research is needed, the authors conclude, but the findings are consistent with previous studies that those with AF continue on rate-control therapy with BBs for a longer amount of time compared to CCBs, indicating that BBs are more effective for long-term ventricular rate control.
Background: For patients with atrial fibrillation (AF), early treatment is essential to prevent serious complications such as stroke. Several randomized clinical trials have shown that rate-control may be as effective as rhythm-control medications, whereas the latter have serious side effects. Little evidence exists, however, about which class of rate-control medication- -blockers (BBs) or calcium channel blockers (CCBs)-may be superior.
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