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The clinical implications of RACE II are that lenient rate control may be adopted as a first-choice rate-control strategy in patients with permanent AF.
The RACE II trial suggested that lenient rate control is non-inferior to strict rate control to prevent major clinical events.
Furthermore, for both patients and health care providers, lenient rate control is more convenient, since fewer outpatient visits and examinations are needed.
In conclusion, lenient rate control was noninferior to strict rate control in the prevention of major cardiovascular events in patients with permanent AF.
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Current guidelines recommend a target heart rate of less than 80 beats per minute, though a "lenient" rate-control strategy (resting heart rate < 110 beats per minute) may be considered in asymptomatic patients with preserved LV function [ 52].
However, a study found that lenient heart rate control with a target resting rate of up to 110 beats per minute is just as beneficial as stricter target heart rates.
Neverthless, since the study was relatively small, large scale studies have to reveal the long term effect of lenient rate vs strict control in patients with AF in more detail (presenter: Isabelle C. Van Gelder, Groningen, The Netherlands).
According to the lenient definition of adequate rate control suggested by RACE-II and proposed in the 2010 ESC guidelines, the vast majority of patients enrolled in the PREFER in AF were adequately rate controlled (Table 3 ).
The available data from the recent Rate Control Efficacy in Permanent Atrial Fibrillation: a Comparison between Lenient vs. Strict Rate Control (RACE) II study, however, do not support this.
The concept of what rate qualifies as adequate has seen some changes recently as the investigators of the RACE II trial reported little difference between aggressive rate control targeting a resting rate of 80 beats per minute (bpm) and the more lenient approach aiming at 110 bpm.
Interest rate control is centralized.
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