Po-01-219 combination of early rhythm control and healthy lifestyle on the risk of stroke in elderly patients with new-onset atrial fibrillation: a korean nationwide population-based cohort study

Early rhythm control and lifestyle modification have both been associated with a lower risk of stroke in patients with atrial fibrillation (AF). However, the impact of early rhythm control strategy in combination with lifestyle modification on the risk of stroke is less clear in elderly population. We evaluated the impact of the combination of ERC and lifestyle modification on the incident stroke in elderly Koreans with new-onset AF. Using the Korean National Health Insurance Service database, we included patients ≥75 years of age with new-onset AF from Jan 2009 to Dec 2016, with national health check data within 2-year after AF diagnosis. Based on questionnaires from health checks, subjects with all the healthy lifestyle (HLS) behaviors (quitting smoking, abstaining from alcohol, and performing regular exercise) were defined as HLS group. Patients who received rhythm control therapy within 2-year after new-onset AF were defined as ERC group. With a two-by-two factorial design, subjects were categorized into 4 groups as follows: (i) those without ERC and HLS (group 1); (ii) those with HLS but without ERC (group 2); (iii) those with ERC but without HLS (group 3); and (iv) those with both ERC and HLS (group 4). The primary outcome was stroke. The average age was 80±4 years and 51% were female. Among a total of 41,315 subjects, 25,093, 8,351, 5,565, and 2,306 were included in group 1, 2, 3, and 4, respectively. In the early rhythm control group (groups 3 and 4), the mean duration from AF diagnosis to rhythm control therapy was 28±84 days. During a median follow-up of 3.7 years, 3,384 had an incident stroke (incidence rate, 8.0 per 100 person-years). After multivariable adjustment, group 2 (healthy lifestyle only) and group 3 (early rhythm control only) were associated with a lower risk of stroke (hazard ratio [HR] and 95% confidence interval [CI]: 0.867, 0.794-0.948, and 0.713, 0.637-0.798, respectively), compared with group 1 (without early rhythm control and healthy lifestyle). Group 4 (both early rhythm control and healthy lifestyle) showed the lowest stroke rate among all groups (HR 0.694, 95% CI 0.586-0.822, compared with group 1) (Figure). In this large-scale observational cohort study, early rhythm control therapy and healthy lifestyle behavior might reduce the risk of stroke in elderly patients with new-onset AF. Implementing early rhythm control in combination with healthy lifestyle should be considered for optimal stroke prevention in these populations.