Cost-Effectiveness of Rhythm versus Rate Control in Atrial Fibrillation

Marshall, Deborah; Levy, Adrian R.; Vidaillet, Humberto; Fenwick, Elisabeth; Slee, April; Blackhouse, Gordon; Greene, H. Leon; Wyse, D. George; Nichol, Graham

doi:10.7326/0003-4819-141-9-200411020-00005

Cited by 98 publications

(41 citation statements)

References 38 publications

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“…Future efforts to reduce this economic burden must be focused on limiting hospitalizations and lengths of stay. Certain interventions such as emergency room observation units versus hospital admission, rate control versus rhythm control, and use of low-molecular-weight heparin versus unfractionated heparin have previously been described [27][28][29] as potential means to reduce the cost associated with the treatment of AF.…”

Section: Discussionmentioning

confidence: 99%

Contemporary Trends of Hospitalization for Atrial Fibrillation in the United States, 2000 Through 2010

et al. 2014

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Background— Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. The associated morbidity and mortality make AF a major public health burden. Hospitalizations account for the majority of the economic cost burden associated with AF. The main objective of this study is to examine the trends of AF-related hospitalizations in the United States and to compare patient characteristics, outcomes, and comorbid diagnoses. Methods and Results— With the use of the Nationwide Inpatient Sample from 2000 through 2010, we identified AF-related hospitalizations using International Classification of Diseases, 9th Revision, Clinical Modification code 427.31 as the principal discharge diagnosis. Overall AF hospitalizations increased by 23% from 2000 to 2010, particularly in patients ≥65 years of age. The most frequent coexisting conditions were hypertension (60.0%), diabetes mellitus (21.5%), and chronic pulmonary disease (20.0%). Overall in-hospital mortality was 1%. The mortality rate was highest in the group of patients ≥80 years of age (1.9%) and in the group of patients with concomitant heart failure (8.2%). In-hospital mortality rate decreased significantly from 1.2% in 2000 to 0.9% in 2010 (29.2% decrease; P <0.001). Although there was no significant change in mean length of stay, mean cost of AF hospitalization increased significantly from $6410 in 2001 to $8439 in 2010 (24.0% increase; P <0.001). Conclusions— Hospitalization rates for AF have increased exponentially among US adults from 2000 to 2010. The proportion of comorbid chronic diseases has also increased significantly. The last decade has witnessed an overall decline in hospital mortality; however, the hospitalization cost has significantly increased.

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Section: Discussionmentioning

confidence: 99%

Contemporary Trends of Hospitalization for Atrial Fibrillation in the United States, 2000 Through 2010

et al. 2014

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“…Given the neutral intention to treat differences for mortality and health related quality of life (QOL), 2 the well done study by Hagens et al assessed costs in a ''straight up'' comparison without the need to adjust costs per QOL improvement. As seen in a similar AFFIRM analysis, 3 the rhythm control strategy was more expensive. Furthermore, the costs did not differ when data were analysed by efficacy (ie, who is, or is not, in sinus rhythm) as opposed to a strict intention to treat analysis.…”

Section: Commentarymentioning

confidence: 68%

Rate control was more cost effective than rhythm control in persistent atrial fibrillation

Newman

2005

Evidence-Based Medicine

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“…21,22,25,27 Therefore, long-term amiodarone therapy, especially at a low dose (100 mg/d), may be cost-effective in patients with intolerant symptoms of persistent AF. 42,43 Our study has important limitations. First, although the total sample size of this meta-analysis is not small (N=5060), the number of patients with heart failure is more limited (n=1587).…”

Section: Discussionmentioning

confidence: 95%

Benefits and Risks of Long-term Amiodarone Therapy for Persistent Atrial Fibrillation: A Meta-analysis

Doyle

2009

Mayo Clinic Proceedings

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OBJECTIVE:To assess whether amiodarone, as part of a strategy to achieve sinus rhythm, is safe and effective compared with a placebo or rate control drug in patients with persistent atrial fibrillation (AF) of more than 30 days' duration. METHODS:Randomized controlled trials comparing amiodarone with a placebo or rate control drug were identified through the EMBASE (January 1, 1988, to October 18, 2008, MEDLINE (January 1, 1966, to October 18, 2008, and Cochrane Controlled Trials Register (second issue 2008) databases with no language restrictions. RESULTS:Twelve randomized controlled trials that involved a total of 5060 patients with persistent AF were considered. Amiodarone was more effective than a placebo or rate control drug in achieving sinus rhythm (21.3 vs 9.2 per 100 patient-years in sinus rhythm; relative risk [RR], 3.2; 95% confidence interval [CI], 1.9-5.5), and its use was not associated with an increased risk of long-term mortality (4.7 vs 3.9 per 100 patient-years; RR, 0.95; 95% CI, 0.8-1

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Cost-Effectiveness of Rhythm versus Rate Control in Atrial Fibrillation

Abstract: Rate control is a cost-effective approach to the management of atrial fibrillation compared with maintenance of sinus rhythm in patients with atrial fibrillation similar to those enrolled in AFFIRM.

Cited by 98 publications

References 38 publications

Contemporary Trends of Hospitalization for Atrial Fibrillation in the United States, 2000 Through 2010

Contemporary Trends of Hospitalization for Atrial Fibrillation in the United States, 2000 Through 2010

Rate control was more cost effective than rhythm control in persistent atrial fibrillation

Benefits and Risks of Long-term Amiodarone Therapy for Persistent Atrial Fibrillation: A Meta-analysis

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