Bibliographic record
Abstract
Current guidelines for the management of atrial fibrillation (AF) recommend an initial approach of either rate control or rhythm control of the arrhythmia based on patient symptoms and preferences.However, AF is a progressive condition that is associated with significant cardiovascular morbidity and mortality.It is biologically plausible that early intervention to prevent the adverse atrial electric, structural, and autonomic remodeling associated with AF might reduce the risk of adverse cardiac outcomes.Until recently, though, empirical evidence for this reasoning has been lacking, because previous randomized clinical trials that failed to find clinical outcomes benefits of rhythm control over rate control predominantly included patients with well-established AF and did not include AF ablation as a rhythm control option.The EAST-AFNET 4 (Early Treatment of Atrial Fibrillation for Stroke Prevention) trial tested the hypothesis that a strategy of early rhythm control therapy that included AF ablation would reduce the risk of adverse cardiovascular outcomes compared with usual care. 1 Patients with early AF (defined as AF diagnosed ≤12 months before enrollment) and underlying cardiovascular conditions (n=2796) were enrolled a median of 36 days after AF diagnosis.More than one-third were enrolled with their first episode of AF, and 30% were asymptomatic from AF (European Heart Rhythm Association class I).Those randomized to early rhythm control were cardioverted if AF was persistent, and initially treated with antiarrhythmic drugs (87%) or AF ablation (8%).By 2 years' follow-up, 19% of participants had undergone AF ablation.Those in the usual care group were treated with rate control therapy that followed AF guidelines and could only cross over to rhythm control for management of ongoing AF-related symptoms.At 2 years, 15% had switched to rhythm control.After a median follow-up of 5.1 years, patients who were randomly assigned to early rhythm control had a lower risk of death from cardiovascular causes, stroke, or hospitalization with worsening of heart failure or acute coronary syndrome (hazard ratio [HR], 0.79 [96% CI, 0.66-0.94];P=0.005).The estimated benefits in this end point were similar across baseline European Heart Rhythm Association AF symptom classes.These patients also experienced a lower risk of 2 of the individual end point components: death from cardiovascular causes (HR, 0.72 [95% CI, 0.52-0.98])and stroke (HR, 0.65 [95% CI, 0.44-0.97]).There was no significant difference in the second primary end point of mean number of nights spent in the hospital between treatment groups (5.8±21.9 and 5.1±15.5 days per year for early rhythm control and usual care, respectively; P=0.23).Rhythm control-related adverse events occurred in 4.9% of patients, with drug-related bradycardia being the most common event.Adverse effects were less frequent and occurred in 1.4% of those receiving usual care. Some limitations of the EAST-AFNET 4 trial design and execution merit discussion. A greater proportion of patients in the early rhythm control group withdrew Rhythm Control of Atrial FibrillationThe Earlier the Better?
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.019 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".