Trial population and intervention
stroke, renal disease stage, chronic kidney disease
RECURRENCE, STROKE, DIABETES MELLITUS, HYPERTENSION, CORONARY ARTERY DISEASE
The EAST-AFNET4 trial was a multi-centre investigator-initiated, parallel-group, open, blinded-outcome-assessment trial. Patients with recently diagnosed AF (<1 year) and cardiovascular risk factors were randomized to early rhythm control or usual care. Inclusion criteria were either patients aged >75 years or prior stroke or two of the following criteria: age >65 years, female sex, HF, hypertension, diabetes mellitus, severe coronary artery disease, chronic kidney disease [modification of diet in renal disease stage 3 or 4 (glomerular filtration rate 15–59 mL/1.73 mRhythm was assessed for all patients at 1 year and 2 years of follow-up. Additionally, recurrent AF was defined in the study protocol as any symptomatic or asymptomatic AF episode (clinically lasting longer than 30 s) after successful index therapy that is documented in an electrocardiogram (ECG). When AF was only documented by a single telemetric ECG, verification of the presence of AF by another technique (standard ECG, Holter ECG or implanted ECG) was required. Any documentation of AF in a standard ECG or Holter ECG constituted an AF recurrence.Patients in the ERC group were also given a single-lead ECG (Vitaphone) to transmit ECGs twice per week and when symptomatic. Documentation of recurrent AF triggered an escalation of rhythm-control therapy as clinically indicated. In UC, rate control was the initial strategy and rhythm control was only used when AF-related symptoms persisted on optimal rate control.