JACC：房颤伴心衰患者的生活质量和运动能力

房颤和心衰是心血管领域最常见的两种疾病，随着发病率的逐年增加，21世纪我们面临的两种最主要的疾病就是房颤和心衰，房颤和心衰往往在同一个患者中出现。AF-CHF研究共入选来自123个中心的1376例房颤伴心衰患者，比较节律控制和心率控制对患者预后的影响，结果提示通过37个月的随访，两组主要终点事件心血管死亡率无明显差异，次要终点事件全因死亡率、心衰恶化、脑卒中均无明显差异。

现有的研究认为节律控制和心率控制对房颤伴心衰患者的预后无明显影响，但是值得一提的目前节律控制治疗后维持窦律的效果还不确切，因此人们期待一些能有效维持窦律的方法能改善患者的临床预后，再者生活质量和活动能力也是人们关注的问题，据此，Suman-Horduna I等通过对AF-CHF研究的进一步分析，旨在探讨节律控制和心率控制对房颤伴心衰患者生活质量和活动能力的影响。

该研究入选AF-CHF研究的1376例心衰合并房颤的患者，分成节律控制和心率控制两组，所有患者通过SF-36生活质量评定量表测定基线时及4个月后的生活质量，通过6分钟步行试验测定患者基线、3周后、4个月后和1年后的活动能力。

结果提示节律控制组和心率控制组的生活质量均得到了改善，然而，维持窦律时间长的患者生命质量评分高。节律控制组和心率控制组的6分钟步行试验和NYHA分级相似，窦性心律维持时间长的患者6分钟步行试验结果较好(p<0.001),但NYHA分级却无明显差异。

通过该项研究可得出以下结论：节律控制和心率控制对心衰合并房颤患者的生活质量和活动能力的改善相似，进一步分析研究发现，窦律维持时间长者生活质量及活动能力改善略优。

doi:10.1016/j.jacc.2012.10.031
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Quality of Life and Functional Capacity in Patients With Atrial Fibrillation and Congestive Heart Failure

Irina Suman-Horduna, MD, MSc; Denis Roy, MD; Nancy Frasure-Smith, PhD; Mario Talajic, MD; François Lespérance, MD; Lucie Blondeau, MSc; Paul Dorian, MD, MSc; Paul Khairy, MD, PhD

Objectives We sought to assess the impact of rhythm- versus rate-control treatment strategies and of underlying rhythm on quality of life and functional capacity in patients with atrial fibrillation (AF) and congestive heart failure (CHF). Background Although intention-to-treat and efficacy analyses have demonstrated similar cardiovascular outcomes in patients with AF and CHF randomized to rhythm or rate control, effects on quality of life remain to be determined. Methods The AF-CHF (Atrial Fibrillation and Congestive Heart Failure) trial randomized 1,376 patients to rhythm- or rate-control strategies. For this pre-specified substudy, Medical Outcomes Short Form-36 questionnaires were administered at baseline and 4 months. Six-min walk tests were conducted at baseline, 3 weeks, 4 months, and 1 year. Results Quality of life improved across all domains to a similar extent with rhythm and rate control. However, a higher proportion of time spent in sinus rhythm was associated with a modestly greater improvement in quality of life scores. Six-min walk distance (p = 0.2328) and New York Heart Association functional class (p = 0.1712) improved to a similar degree with rhythm and rate control. A higher proportion of time spent in sinus rhythm was associated with a greater improvement in New York Heart Association functional class (p < 0.0001) but not in 6-min walk distance (p = 0.1308). Conclusions Improvements in quality of life and functional capacity were similar in patients with AF and CHF randomized to rhythm- versus rate-control strategies. By contrast, sinus rhythm was associated with beneficial effects on New York Heart Association functional class and modest gains in quality of life. (Atrial Fibrillation and Congestive Heart Failure [AF-CHF]; NCT00597077).