RACE 3: early benefits targeted therapy in AF and HF diminished at 5-year follow-up

In the RACE 3 trial, patients with early persistent atrial fibrillation (AF) and heart failure (HF) received either conventional plus targeted therapies or conventional therapies alone. While results were promising at 1-year, results from 5-year follow-up did not show superior efficacy of combined treatment [1].

Targeted therapies refer to interventions that aim to modify the atrial substrate and have a favourable effect on risk factors and diseases underlying AF. The aim of the RACE 3 trial (NCT00877643) was to study the long-term effects of targeted therapies on maintenance of sinus rhythm, cardiovascular (CV) morbidity, and mortality after 5 years.

Patients with early AF and HF were randomly treated with either conventional therapies (n=109) or conventional plus targeted therapies (i.e. mineralocorticoid receptor antagonists, statins, ACE-inhibitors and/or angiotensin-receptor blockers, and cardiac rehabilitation; n=107). After 3 weeks, all patients were electrocardioverted and received rhythm control and HF therapy. The primary endpoint was 1-year sinus rhythm on 7-day Holter, the secondary endpoint was CV morbidity and mortality. Prof. Michiel Rienstra (University Medical Center Groningen, the Netherlands) presented the 5-year follow-up results.

After 1 year, 75% of participants receiving targeted therapy were in sinus rhythm versus 63% of participants receiving only conventional therapy (P=0.042), showing superiority of targeted therapy. The recent 5-year outcomes show that 46% versus 39% of participants were in sinus rhythm (P=0.346), showing no statistically significant difference in efficacy. Evaluation of the secondary endpoint at 5 years showed that only 16% of patients suffered from CV morbidity or mortality and there was no difference between the treatment arms.

Prof. Rienstra concluded that the RACE 3 study demonstrated that targeted therapies on top of conventional studies do not improve maintenance of sinus rhythm at 5-year follow-up in patients with persistent AF and HF.

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   1. Rienstra M. Targeted therapy of underlying conditions in patients with persistent atrial fibrillation and mild to moderate stable heart failure: long-term outcome of the RACE 3 Trial. 2021 EHRA Congress, 23-25 April.

 



Posted on 24 April, 202116 June, 2021