Cv4: Using Uk Observational Data to Identify Possibilities for the Cost-Effective Improvement of the Treatment of Atrial Fibrillation

Abstract

BACKGROUND: Atrial Fibrillation (AF) is the most frequent type of arrhythmia. Termination of acute AF is generally undertaken in a hospital setting. Available drugs for termination of acute AF have severe side effects and complicated dose regimens. There is a need for new drugs with a high conversion rate, favourable safety profile and easier dosing. OBJECTIVES: To describe the characteristics and hospital treatment patterns of patients with AF. To investigate the requirements for an improved cost‐effective anti‐arrhythmic therapy. METHODS: A database was used containing aggregated and anonymised diagnostic information, hospital experience (e.g., length of stay), and demographic data for over 80 million inpatient episodes in the UK over ten years. The database contains 28,524 hospital admissions of patients (65 and over) with a diagnosis of AF during 1999/2000. 53.3% are female, with mean length of stay (LOS) 6.1 days; 46.7% are male with LOS 4.3 days. Controlling for age, the gender LOS difference is significant (p < 0.01). RESULTS: Comorbid Conditions. 17.5% of AF patients also had a diagnosis of chronic ischaemic heart disease (IHD), a further 7.5% had myocardial ischaemia, and 19.5%, congestive heart failure. Furthermore, 24.2% of CHF patients and 16.9% of all angina patients also had clinically significant AF. Cardioversion. Cardioversion (defibrillation) is used when pharmacological therapy fails to terminate acute AF. However, significant numbers (35%) of cardioversion procedures were undertaken on an elective day case basis. We are currently investigating and will report on the resource consequences in acute AF. CONCLUSIONS: There is a clear unmet medical need for improved anti‐arrhythmic drugs. Using the dataset, we identify two potentially cost‐effective possibilities for improved anti‐arrhythmic treatment: an agent which can simultaneously demonstrate effectiveness in associated cardiovascular conditions such as IHD or CHF; or an agent reducing the need for cardioversion in acute AF.