In-hospital therapies and determinants of treatment strategy selection in patients with atrial fibrillation and left ventricular systolic dysfunction in China: a retrospective study based on the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) project, 2015-2019

Objectives The optimal treatment strategy remains debatable in patients with atrial fibrillation (AF) and heart failure. Our objectives were to summarise in-hospital therapies and determine factors associated with treatment strategy selections. Design A retrospective study analysing the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) project from 2015 to 2019. Setting The CCC-AF project included patients from 151 tertiary and 85 secondary hospitals across 30 provinces in China. Participants Patients with AF and left ventricular systolic dysfunction (LVSD, defined as left ventricular ejection fraction<50%) were included, with 5560 patients in the study sample. Methods Patients were classified by treatment strategies. In-hospital treatments and trends of therapies were analysed. Multiple logistic regression models were used to find determinants of treatment strategies. Results Rhythm control therapies were used in 16.9% of patients with no significant trends (p trend=0.175). Catheter ablation was used in 5.5% of patients, increasing from 3.3% in 2015 to 6.6% in 2019 (p trend<0.001). Factors negatively associated with rhythm control included increased age (OR 0.973, 95%CI 0.967 to 0.980), valvular AF (OR 0.618, 95%CI 0.419 to 0.911), AF types (persistent: OR 0.546, 95%CI 0.462 to 0.645; long-standing persistent: OR 0.298, 95%CI 0.240 to 0.368), larger left atrial diameters (OR 0.966, 95%CI 0.957 to 0.976) and higher Charlson Comorbidity Index scores (CCI 1-2: OR 0.630, 95%CI 0.529 to 0.750; CCI >= 3: OR 0.551, 95%CI 0.390 to 0.778). Higher platelet counts (OR 1.025, 95%CI 1.013 to 1.037) and prior rhythm control attempts (electrical cardioversion: OR 4.483, 95%CI 2.369 to 8.483; catheter ablation: OR 4.957, 95%CI 3.072 to 7.997) were positively associated with rhythm control strategies. Conclusion In China, non-rhythm control strategy remained the dominant choice in patients with AF and LVSD. Age, AF types, prior treatments, left atrial diameters, platelet counts and comorbidities were major determinants of treatment strategies. Guideline-adherent therapies should be further promoted.