Evidence mapPaperPMID 41559252Full record

Observational studyInternal and emergency medicine2026

Optimal heart rate in patients with atrial fibrillation: insights from the COOL-AF registry.

Rungroj Krittayaphong, Arintaya Phrommintikul, Chulaluk Komoltri, Ahthit Yindeengam, Gregory Y H Lip

Abstract readMulticenter StudyObservational Study
PubMed Publisher
In one paragraph

Observational study in Internal and emergency medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Rungroj KrittayaphongDivision of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand. rungroj.kri@mahidol.ac.th.
Arintaya PhrommintikulFaculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Chulaluk KomoltriDepartment of Research Promotion, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Ahthit YindeengamHer Majesty Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Gregory Y H LipLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.

Funding

Health Systems Research Institute 59-053
6 · The paper itself

Abstract

Heart rate control is an important strategy for the management of patients with atrial fibrillation (AF). However, there remains some uncertainty for the optimal target heart rate of AF patients. COOL-AF was a prospective multicenter registry of patients with non-valvular AF. Patients were followed-up every 6 months until 3 years. The primary outcome was the composite of cardiovascular death, heart failure, and ischemic stroke/systemic embolism (SSE). A total of 3405 patients were studied (mean age 67.8 ± 11.3 years; 41.8% female). Mean heart rate was 77.4 ± 16.2 bpm. Number of patients with baseline heart rate < 60, 60-80, 80-100, and ≥ 100 bpm was 371 (10.9%), 1616 (47.4%), 1116 (32.8%), and 302 (8.9%), respectively. The overall incidence rates of the composite outcome, heart failure event, CV death, and SSE were 4.97 (4.51-5.47), 2.84 (2.49-3.21), 1.34 (1.11-1.60), and 1.51 (1.26-1.78) per 100 person-years, respectively. When compared to those with heart rate in the range 60-80 bpm, AF patient with heart rate > 100 bpm had the highest incidence rate of the composite outcome (7.06 per 100 person-years) with the unadjusted and adjusted hazard ratios (95%CI) of 1.59 (1.17, 2.16) (p = 0.003) and 1.51 (1.11-2.07) (p = 0.009), respectively. The analysis of dynamic changes in heart rate demonstrated more prominent results with the unadjusted and adjusted hazard ratios (95%CI) of 1.84 (1.40, 2.40) (p < 0.001) and 1.76 (1.34-2.37) (p < 0.001), respectively. In conclusion, there is a J-curve pattern for the relation of baseline resting heart rate and the composite outcome in patients with AF. Patients with heart rate greater than 100 are the highest risk group.

Indexed as

Atrial FibrillationHeart RateAgedAged, 80 and overFemaleHeart FailureHumansMaleMiddle AgedProspective StudiesRegistriesAtrial fibrillationDeathHeart failureHeart rateIschemic stroke

Identifiers

PMID41559252

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.