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Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149:e1-e156. [PMID: 38033089 PMCID: PMC11095842 DOI: 10.1161/cir.0000000000001193] [Citation(s) in RCA: 134] [Impact Index Per Article: 134.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
AIM The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines liaison
| | | | | | | | | | - Paul L Hess
- ACC/AHA Joint Committee on Performance Measures liaison
| | | | | | | | | | - Kazuhiko Kido
- American College of Clinical Pharmacy representative
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2
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Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024; 83:109-279. [PMID: 38043043 PMCID: PMC11104284 DOI: 10.1016/j.jacc.2023.08.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
AIM The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Patients With Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
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Deering TF, Goyal SK, Bhimani AA, Hoosien M, Karimianpour A, Krishnasamy KP, Nilsson KR, Omar A, Lakkireddy D, Gopinathannair R, Katapadi A, Sohns C. Atrial fibrillation ablation in heart failure patients: Where do we stand in 2023? - State of the art review. Pacing Clin Electrophysiol 2024; 47:88-100. [PMID: 38071456 DOI: 10.1111/pace.14888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/08/2023] [Accepted: 11/15/2023] [Indexed: 01/11/2024]
Abstract
Atrial fibrillation (AF) and heart failure are common overlapping cardiovascular disorders. Despite important therapeutic advances over the past several decades, controversy persists about whether a rate control or rhythm control approach constitutes the best option in this population. There is also considerable debate about whether antiarrhythmic drug therapy or ablation is the best approach when rhythm control is pursued. A brief historical examination of the literature addressing this issue will be performed. An analysis of several important clinical outcomes observed in the prospective, randomized studies, which have compared AF ablation to non-ablation treatment options, will be discussed. This review will conclude with recommendations to guide clinicians on the status of AF ablation as a treatment option when considering management options in heart failure patients with atrial fibrillation.
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Affiliation(s)
- Thomas F Deering
- Department of Cardiac Electrophysiology, Piedmont Heart Institute, Atlanta, Georgia, USA
- Department of Cardiology, Augusta University, Athens, Georgia, USA
| | - Sandeep K Goyal
- Department of Cardiac Electrophysiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Ashish A Bhimani
- Department of Cardiac Electrophysiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Michael Hoosien
- Department of Cardiac Electrophysiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Ahmadreza Karimianpour
- Department of Cardiac Electrophysiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Kavita P Krishnasamy
- Department of Cardiac Electrophysiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Kent R Nilsson
- Department of Cardiac Electrophysiology, Piedmont Heart Institute, Atlanta, Georgia, USA
- Department of Cardiology, Augusta University, Athens, Georgia, USA
| | - Abdullah Omar
- Department of Cardiac Electrophysiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas, USA
| | - Rakesh Gopinathannair
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas, USA
| | - Aashish Katapadi
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas, USA
| | - Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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Nguyen D, Marwick T, Moodie M, Gao L. Early offering transcatheter aortic valve replacement to patients with moderate aortic stenosis: quantifying costs and benefits - a Markov model-based simulation study. BMJ Open 2023; 13:e073254. [PMID: 37993164 PMCID: PMC10668295 DOI: 10.1136/bmjopen-2023-073254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023] Open
Abstract
OBJECTIVE Aortic stenosis (AS) is one of the most common acquired cardiac valvular diseases. The success of transcatheter aortic valve implantation (TAVI) for severe AS has led to increasing interest in its use to earlier disease-moderate AS (MAS). DESIGN Model-based study using a Markov microsimulation technique to evaluate the long-term costs and benefits associated with 'early' TAVI. Key data inputs were sourced from the international literature and costs were obtained from Australian sources. SETTING Australian health care system perspective. PARTICIPANTS 10 000 hypothetical MAS patients with or without left ventricular diastolic dysfunction or impaired left ventricular ejection fraction. INTERVENTION Comparing early TAVI to medical management over a life time horizon for MAS patients aged >65 years. We evaluated the cost-effectiveness of offering early TAVI in five scenarios (10%, 25%, 50%, 75% and 90% take-up rates). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure is quality-adjusted life years (QALY) gained and the incremental cost-utility ratio (ICUR). Secondary outcomes are life-years gained and the number of heart failure case avoided. RESULTS Offering early TAVI for MAS patients resulted in both higher healthcare costs and greater benefits (an increase of 3.02 QALYs or 3.99 life-years) per person treated. The ICUR was around $A10 867 and $A11 926 per QALY gained for all five scenarios, with the total cost of early TAVI to the healthcare system being anticipated to be up to $A3.66 billion. Sensitivity analyses indicated a 100% probability of being cost-effective with a willingness to pay threshold of $A50 000/QALY. The benefits remained, even with assumptions of high levels of repeat valve replacement after TAVI. CONCLUSION While ongoing randomised controlled trials will define the benefit of TAVI to MAS patients, these results suggest that this intervention is likely to be cost-effective.
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Affiliation(s)
- Dieu Nguyen
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Tom Marwick
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Lan Gao
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University Faculty of Health, Geelong, Victoria, Australia
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Zeitler EP, Kim MH. Resource Use Following Atrial Fibrillation Ablation: Spending Resources to Save Resources. J Am Heart Assoc 2023; 12:e031411. [PMID: 37681513 PMCID: PMC10547283 DOI: 10.1161/jaha.123.031411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Affiliation(s)
- Emily P. Zeitler
- Dartmouth‐Hitchcock Medical Center and The Dartmouth InstituteLebanonNH
- The Geisel School of Medicine at DartmouthHanoverNH
| | - Michael H. Kim
- Creighton University School of Medicine and CHI HealthOmahaNE
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Hijazi W, Vandenberk B, Rennert-May E, Quinn A, Sumner G, Chew DS. Economic evaluation in cardiac electrophysiology: Determining the value of emerging technologies. Front Cardiovasc Med 2023; 10:1142429. [PMID: 37180811 PMCID: PMC10169721 DOI: 10.3389/fcvm.2023.1142429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Cardiac electrophysiology is a constantly evolving speciality that has benefited from technological innovation and refinements over the past several decades. Despite the potential of these technologies to reshape patient care, their upfront costs pose a challenge to health policymakers who are responsible for the assessment of the novel technology in the context of increasingly limited resources. In this context, it is critical for new therapies or technologies to demonstrate that the measured improvement in patients' outcomes for the cost of achieving that improvement is within conventional benchmarks for acceptable health care value. The field of Health Economics, specifically economic evaluation methods, facilitates this assessment of value in health care. In this review, we provide an overview of the basic principles of economic evaluation and provide historical applications within the field of cardiac electrophysiology. Specifically, the cost-effectiveness of catheter ablation for both atrial fibrillation (AF) and ventricular tachycardia, novel oral anticoagulants for stroke prevention in AF, left atrial appendage occlusion devices, implantable cardioverter defibrillators, and cardiac resynchronization therapy will be reviewed.
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Affiliation(s)
- Waseem Hijazi
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Bert Vandenberk
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Elissa Rennert-May
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Amity Quinn
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Glen Sumner
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Derek S. Chew
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
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7
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Kim W, Kim M, Kim YT, Park W, Kim JB, Kim C, Joung B. Cost-effectiveness of rhythm control strategy: Ablation versus antiarrhythmic drugs for treating atrial fibrillation in Korea based on real-world data. Front Cardiovasc Med 2023; 10:1062578. [PMID: 36760559 PMCID: PMC9902500 DOI: 10.3389/fcvm.2023.1062578] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
Background Ablation-based treatment has emerged as an alternative rhythm control strategy for symptomatic atrial fibrillation (AF). Recent studies have demonstrated the cost-effectiveness of ablation compared with medical therapy in various circumstances. We assessed the economic comparison between ablation and medical therapy based on a nationwide real-world population. Methods and findings For 192,345 patients with new-onset AF (age ≥ 18 years) identified between August 2015 and July 2018 from the Korean Health Insurance Review and Assessment Service (HIRA) database, medical resource use data were collected to compare AF patients that underwent ablation (N = 2,131) and those administered antiarrhythmic drugs (N = 8,048). Subsequently, a Markov chain Monte Carlo model was built. The patients had at least one risk factor for stroke, and the base-case used a 20-year time horizon, discounting at 4.5% annually. Transition probabilities and costs were estimated using the present data, and utilities were derived from literature review. The costs were converted to US $ (2019). Sensitivity analyses were performed using probabilistic and deterministic methods. The net costs and quality-adjusted life years (QALY) for antiarrhythmic drugs and ablation treatments were $37,421 and 8.8 QALYs and $39,820 and 9.3 QALYs, respectively. Compared with antiarrhythmic drugs, incremental cost-effectiveness ratio of ablation was $4,739/QALY, which is lower than the willingness-to-pay (WTP) threshold of $32,000/QALY. Conclusion In symptomatic AF patients with a stroke risk under the age of 75 years, ablation-based rhythm control is potentially a more economically attractive option compared with antiarrhythmic drug-based rhythm control in Korea.
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Affiliation(s)
- Woojin Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Kim
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Yun Tae Kim
- Department of Public Health, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Woongbi Park
- Department of Public Health, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Jin-bae Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea,*Correspondence: Jin-bae Kim,
| | - Changsoo Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea,Institute of Human Complexity and Systems Science, Yonsei University, Incheon, Republic of Korea,Changsoo Kim,
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea,Boyoung Joung,
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8
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Tschugguel W. A transitive perspective on the relief of psychosomatic symptoms. Front Psychol 2022; 13:821566. [PMID: 36317186 PMCID: PMC9616690 DOI: 10.3389/fpsyg.2022.821566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 09/27/2022] [Indexed: 11/25/2022] Open
Abstract
A key element of successful psychotherapy for the treatment of psychosomatic disorders is that patients recognize and change the meaning of their experiences. Such changes are brought about by appropriate verbal referencing of symptoms currently experienced within a given narrative. The present theoretical paper argues that changes are not based on better, more adaptive narratives per se, but on the transition (or linkage) process itself that is experienced between different narratives. This view is theoretically justified in various ways: first, it is accounted for through contemporary spatiotemporal neuroscience, which aims to connect mental and structural aspects via a common dynamic property or, according to Northoff, the "common currency" of a brain's orientation along its embeddedness in its contextual world, i.e., body and environment. Second, it is justified through the physics concept of "spontaneous symmetry breaking," which is used analogously to "suffering from symptoms." If the sufferer is willing to experience a process of "going back," that is, moving away from the previous narrative (or aspect) by verbally relating to the felt aspects of the symptom in question (i.e., approaching its meaning), they are moving toward symmetry or an underlying dynamic alignment with their world context. Clinical predictions are derived from the theoretical arguments.
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Affiliation(s)
- Walter Tschugguel
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
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9
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Huang X, Yang S, Chen X, Zhao Q, Pan J, Lai S, Ouyang F, Deng L, Du Y, Chen J, Hu Q, Guo B, Liu J. Development and validation of a clinical predictive model for 1-year prognosis in coronary heart disease patients combine with acute heart failure. Front Cardiovasc Med 2022; 9:976844. [PMID: 36312262 PMCID: PMC9609152 DOI: 10.3389/fcvm.2022.976844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background The risk factors for acute heart failure (AHF) vary, reducing the accuracy and convenience of AHF prediction. The most common causes of AHF are coronary heart disease (CHD). A short-term clinical predictive model is needed to predict the outcome of AHF, which can help guide early therapeutic intervention. This study aimed to develop a clinical predictive model for 1-year prognosis in CHD patients combined with AHF. Materials and methods A retrospective analysis was performed on data of 692 patients CHD combined with AHF admitted between January 2020 and December 2020 at a single center. After systemic treatment, patients were discharged and followed up for 1-year for major adverse cardiovascular events (MACE). The clinical characteristics of all patients were collected. Patients were randomly divided into the training (n = 484) and validation cohort (n = 208). Step-wise regression using the Akaike information criterion was performed to select predictors associated with 1-year MACE prognosis. A clinical predictive model was constructed based on the selected predictors. The predictive performance and discriminative ability of the predictive model were determined using the area under the curve, calibration curve, and clinical usefulness. Results On step-wise regression analysis of the training cohort, predictors for MACE of CHD patients combined with AHF were diabetes, NYHA ≥ 3, HF history, Hcy, Lp-PLA2, and NT-proBNP, which were incorporated into the predictive model. The AUC of the predictive model was 0.847 [95% confidence interval (CI): 0.811–0.882] in the training cohort and 0.839 (95% CI: 0.780–0.893) in the validation cohort. The calibration curve indicated good agreement between prediction by nomogram and actual observation. Decision curve analysis showed that the nomogram was clinically useful. Conclusion The proposed clinical prediction model we have established is effective, which can accurately predict the occurrence of early MACE in CHD patients combined with AHF.
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Affiliation(s)
- Xiyi Huang
- Department of Clinical Laboratory, The Affiliated Shunde Hospital of Guangzhou Medical University, Foshan, China
| | - Shaomin Yang
- Department of Radiology, The Affiliated Shunde Hospital of Guangzhou Medical University, Foshan, China
| | - Xinjie Chen
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Qiang Zhao
- Department of Cardiovascular Medicine, The Affiliated Shunde Hospital of Guangzhou Medical University, Foshan, China
| | - Jialing Pan
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Shaofen Lai
- Department of Clinical Laboratory, The Affiliated Shunde Hospital of Guangzhou Medical University, Foshan, China
| | - Fusheng Ouyang
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Lingda Deng
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Yongxing Du
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Jiacheng Chen
- Department of Clinical Laboratory, The Affiliated Shunde Hospital of Guangzhou Medical University, Foshan, China
| | - Qiugen Hu
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Baoliang Guo
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China,*Correspondence: Baoliang Guo,
| | - Jiemei Liu
- Department of Rehabilitation Medicine, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China,Jiemei Liu,
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10
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Chew DS, Li Y, Cowper PA, Anstrom KJ, Piccini JP, Poole JE, Daniels MR, Monahan KH, Davidson-Ray L, Bahnson TD, Al-Khalidi HR, Lee KL, Packer DL, Mark DB. Cost-Effectiveness of Catheter Ablation Versus Antiarrhythmic Drug Therapy in Atrial Fibrillation: The CABANA Randomized Clinical Trial. Circulation 2022; 146:535-547. [PMID: 35726631 PMCID: PMC9378541 DOI: 10.1161/circulationaha.122.058575] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND In the CABANA trial (Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation), catheter ablation did not significantly reduce the primary end point of death, disabling stroke, serious bleeding, or cardiac arrest compared with drug therapy by intention-to-treat, but did improve the quality of life and freedom from atrial fibrillation recurrence. In the heart failure subgroup, ablation improved both survival and quality of life. Cost-effectiveness was a prespecified CABANA secondary end point. METHODS Medical resource use data were collected for all CABANA patients (N=2204). Costs for hospital-based care were assigned using prospectively collected bills from US patients (n=1171); physician and medication costs were assigned using the Medicare Fee Schedule and National Average Drug Acquisition Costs, respectively. Extrapolated life expectancies were estimated using age-based survival models. Quality-of-life adjustments were based on EQ-5D-based utilities measured during the trial. The primary outcome was the incremental cost-effectiveness ratio, comparing ablation with drug therapy on the basis of intention-to-treat, and assessed from the US health care sector perspective. RESULTS Costs in the first 3 months averaged $20 794±SD 1069 higher with ablation compared with drug therapy. The cumulative within-trial 5-year cost difference was $19 245 (95% CI, $11 360-$27 170) and the lifetime mean cost difference was $15 516 (95% CI, -$2963 to $35,512) higher with ablation than with drug therapy. The drug therapy arm accrued an average of 12.5 life-years (LYs) and 10.7 quality-adjusted life-years (QALYs). For the ablation arm, the corresponding estimates were 12.6 LYs and 11.0 QALYs. The incremental cost-effectiveness ratio was $57 893 per QALY gained, with 75% of bootstrap replications yielding an incremental cost-effectiveness ratio <$100 000 per QALY gained. With no quality-of-life/utility adjustments, the incremental cost-effectiveness ratio was $183 318 per LY gained. CONCLUSIONS Catheter ablation of atrial fibrillation was economically attractive compared with drug therapy in the CABANA Trial overall at present benchmarks for health care value in the United States on the basis of projected incremental QALYs but not LYs alone.
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Affiliation(s)
- Derek S Chew
- Duke Clinical Research Institute (D.S.C., Y.L., P.A.C., K.J.A., J.P.P., M.R.D., L.D.-R., T.D.B., H.R.A.-K., K.L.L., D.B.M.), Duke University, Durham, NC
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Alberta, Canada (D.S.C.)
| | - Yanhong Li
- Duke Clinical Research Institute (D.S.C., Y.L., P.A.C., K.J.A., J.P.P., M.R.D., L.D.-R., T.D.B., H.R.A.-K., K.L.L., D.B.M.), Duke University, Durham, NC
| | - Patricia A Cowper
- Duke Clinical Research Institute (D.S.C., Y.L., P.A.C., K.J.A., J.P.P., M.R.D., L.D.-R., T.D.B., H.R.A.-K., K.L.L., D.B.M.), Duke University, Durham, NC
| | - Kevin J Anstrom
- Duke Clinical Research Institute (D.S.C., Y.L., P.A.C., K.J.A., J.P.P., M.R.D., L.D.-R., T.D.B., H.R.A.-K., K.L.L., D.B.M.), Duke University, Durham, NC
- Department of Biostatistics and Bioinformatics (K.J.A., H.R.A.-K., K.L.L.), Duke University, Durham, NC
- Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC (K.J.A.)
| | - Jonathan P Piccini
- Duke Clinical Research Institute (D.S.C., Y.L., P.A.C., K.J.A., J.P.P., M.R.D., L.D.-R., T.D.B., H.R.A.-K., K.L.L., D.B.M.), Duke University, Durham, NC
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (J.P.P., T.D.B., D.B.M.)
| | - Jeanne E Poole
- University of Washington Medical Center, Seattle (J.E.P.)
| | - Melanie R Daniels
- Duke Clinical Research Institute (D.S.C., Y.L., P.A.C., K.J.A., J.P.P., M.R.D., L.D.-R., T.D.B., H.R.A.-K., K.L.L., D.B.M.), Duke University, Durham, NC
| | | | - Linda Davidson-Ray
- Duke Clinical Research Institute (D.S.C., Y.L., P.A.C., K.J.A., J.P.P., M.R.D., L.D.-R., T.D.B., H.R.A.-K., K.L.L., D.B.M.), Duke University, Durham, NC
| | - Tristram D Bahnson
- Duke Clinical Research Institute (D.S.C., Y.L., P.A.C., K.J.A., J.P.P., M.R.D., L.D.-R., T.D.B., H.R.A.-K., K.L.L., D.B.M.), Duke University, Durham, NC
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (J.P.P., T.D.B., D.B.M.)
| | - Hussein R Al-Khalidi
- Duke Clinical Research Institute (D.S.C., Y.L., P.A.C., K.J.A., J.P.P., M.R.D., L.D.-R., T.D.B., H.R.A.-K., K.L.L., D.B.M.), Duke University, Durham, NC
- Department of Biostatistics and Bioinformatics (K.J.A., H.R.A.-K., K.L.L.), Duke University, Durham, NC
| | - Kerry L Lee
- Duke Clinical Research Institute (D.S.C., Y.L., P.A.C., K.J.A., J.P.P., M.R.D., L.D.-R., T.D.B., H.R.A.-K., K.L.L., D.B.M.), Duke University, Durham, NC
- Department of Biostatistics and Bioinformatics (K.J.A., H.R.A.-K., K.L.L.), Duke University, Durham, NC
| | | | - Daniel B Mark
- Duke Clinical Research Institute (D.S.C., Y.L., P.A.C., K.J.A., J.P.P., M.R.D., L.D.-R., T.D.B., H.R.A.-K., K.L.L., D.B.M.), Duke University, Durham, NC
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (J.P.P., T.D.B., D.B.M.)
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11
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Leung LWM, Akhtar Z, Kontogiannis C, Imhoff RJ, Taylor H, Gallagher MM. Economic Evaluation of Catheter Ablation Versus Medical Therapy for the Treatment of Atrial Fibrillation from the Perspective of the UK. Arrhythm Electrophysiol Rev 2022; 11:e13. [PMID: 35846425 PMCID: PMC9277614 DOI: 10.15420/aer.2021.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 03/14/2022] [Indexed: 12/17/2022] Open
Abstract
Randomised evidence supports an early rhythm control strategy as treatment for AF, and catheter ablation outperforms medical therapy in terms of effectiveness when studied as first- and second-line treatment. Despite evidence consistently showing that catheter ablation treatment is superior to medical therapy in most AF patients, only a small proportion receive ablation, in some cases after a prolonged trial of ineffective medical therapy. Health economics research in electrophysiology remains limited but is recognised as being important in influencing positive change to ensure early access to ablation services for all eligible patients. Such information has informed the updated recommendations from the recently published National Institute for Health and Care Excellence clinical guideline on the diagnosis and management of AF, but increased awareness is needed to drive real-world adoption and to ensure patients are quickly referred to specialists. In this article, economic evaluations of catheter ablation versus medical therapy are reviewed.
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Affiliation(s)
- Lisa WM Leung
- Department of Cardiology, St George’s Hospital NHS Foundation Trust, London, UK
| | - Zaki Akhtar
- Department of Cardiology, St George’s Hospital NHS Foundation Trust, London, UK
| | | | - Ryan J Imhoff
- Real-World Evidence and Late Phase Research, CTI Clinical Trial and Consulting Services Inc, Covington, KY, US
| | | | - Mark M Gallagher
- Department of Cardiology, St George’s Hospital NHS Foundation Trust, London, UK
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12
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Meta-Analysis of Catheter Ablation versus Medical Therapy for Heart Failure Complicated with Atrial Fibrillation. Cardiol Res Pract 2021; 2021:7245390. [PMID: 34912577 PMCID: PMC8668366 DOI: 10.1155/2021/7245390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/28/2021] [Accepted: 11/23/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To compare the efficacy of catheter ablation and medical therapy in patients with heart failure and atrial fibrillation. Methods We searched randomized controlled trials comparing catheter ablation versus medical therapy for heart failure and atrial fibrillation through PubMed, MEDLINE, Embase, Cochrane Clinical Trials Database, Web of Science, and China National Knowledge Infrastructure. Articles were investigated for their methodological quality using the Cochrane Collaboration risk of the bias assessment tool. Forest plots, funnel plots, and sensitivity analysis were also performed on the included articles. Results were expressed as risk ratio (RR) and mean difference (MD) with 95% confidence intervals. Results Nine (9) studies were included in this study with 1131 patients. Meta-analysis showed a reduction in all-cause mortality from catheter ablation compared with medical therapy (RR = 0.53, 95% CI = 0.37 to 0.76; P=0.0007) and improved left ventricular ejection fraction (LVEF) (MD = 6.45, 95% CI = 3.49 to 9.41; P < 0.0001), 6-minute walking time (6MWT) (MD = 28.32, 95% CI = 17.77 to 38.87; P < 0.0001), and Minnesota Living with Heart Failure Questionnaire (MLHFQ) score (MD = 8.19, 95% CI = 0.30 to 16.08; P=0.04). Conclusion Catheter ablation had a better improvement than medical treatment in left ventricular ejection fraction, cardiac function, and exercise ability for atrial fibrillation and heart failure patients.
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13
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Leung LWM, Imhoff RJ, Marshall HJ, Frame D, Mallow PJ, Goldstein L, Wei T, Velleca M, Taylor H, Gallagher MM. Cost-effectiveness of catheter ablation versus medical therapy for the treatment of atrial fibrillation in the United Kingdom. J Cardiovasc Electrophysiol 2021; 33:164-175. [PMID: 34897897 PMCID: PMC9300178 DOI: 10.1111/jce.15317] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/21/2021] [Accepted: 10/27/2021] [Indexed: 11/30/2022]
Abstract
Introduction Research evidence has shown that catheter ablation is a safe and superior treatment for atrial fibrillation (AF) compared to medical therapy, but real‐world practice has been slow to adopt an early interventional approach. This study aims to determine the cost effectiveness of catheter ablation compared to medical therapy from the perspective of the United Kingdom. Methods A patient‐level Markov health‐state transition model was used to conduct a cost‐utility analysis. The population included patients previously treated for AF with medical therapy, including those with heart failure (HF), simulated over a lifetime horizon. Data sources included published literature on utilization and cardiovascular event rates in real world patients, a systematic literature review and meta‐analysis of randomized controlled trials for AF recurrence, and publicly available government data/reports on costs. Results Catheter ablation resulted in a favorable incremental cost‐effectiveness ratio (ICER) of £8614 per additional quality adjusted life years (QALY) gained when compared to medical therapy. More patients in the medical therapy group failed rhythm control at any point compared to catheter ablation (72% vs. 24%) and at a faster rate (median time to treatment failure: 3.8 vs. 10 years). Additionally, catheter ablation was estimated to be more cost‐effective in patients with AF and HF (ICER = £6438) and remained cost‐effective over all tested time horizons (10, 15, and 20 years), with the ICER ranging from £9047–£15 737 per QALY gained. Conclusion Catheter ablation is a cost‐effective treatment for atrial fibrillation, compared to medical therapy, from the perspective of the UK National Health Service.
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Affiliation(s)
- Lisa W M Leung
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Ryan J Imhoff
- Real-World Evidence and Late Phase Research, CTI Clinical Trial and Consulting Services, Covington, Kentucky, USA
| | | | - Diana Frame
- Real-World Evidence and Late Phase Research, CTI Clinical Trial and Consulting Services, Covington, Kentucky, USA
| | - Peter J Mallow
- Health Services Administration, Xavier University, Cincinnati, Ohio, USA
| | - Laura Goldstein
- Franchise Health Economics and Market Access, Biosense Webster, Inc, Irvine, California, USA
| | - Tom Wei
- Franchise Health Economics and Market Access, Biosense Webster, Inc, Irvine, California, USA
| | - Maria Velleca
- Health Economics and Market Access, Johnson & Johnson Medical S.p.A, Pomezia, Italy
| | - Hannah Taylor
- Health Economics and Market Access, Johnson & Johnson Medical Limited, Berkshire, UK
| | - Mark M Gallagher
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, London, UK
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14
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Lau D, Sandhu RK, Andrade JG, Ezekowitz J, So H, Klarenbach S. Cost-Utility of Catheter Ablation for Atrial Fibrillation in Patients with Heart Failure: An Economic Evaluation. J Am Heart Assoc 2021; 10:e019599. [PMID: 34238020 PMCID: PMC8483474 DOI: 10.1161/jaha.120.019599] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Recent trials comparing catheter ablation to medical therapy in patients with heart failure (HF) with symptomatic atrial fibrillation despite first-line management have demonstrated a reduction in adverse outcomes. We performed an economic evaluation to estimate the cost-utility of catheter ablation as second line therapy in patients with HF with reduced ejection fraction. Methods and Results A Markov model with health states of alive, dead, and alive with amiodarone toxicity was constructed, using the perspective of the Canadian healthcare payer. Patients in the alive states were at risk of HF and non-HF hospitalizations. Parameters were obtained from randomized trials and Alberta health system data for costs and outcomes. A lifetime time horizon was adopted, with discounting at 3.0% annually. Probabilistic and 1-way sensitivity analyses were performed. Costs are reported in 2018 Canadian dollars. A patient treated with catheter ablation experienced lifetime costs of $64 960 and 5.63 quality-adjusted life-years (QALY), compared with $49 865 and 5.18 QALYs for medical treatment. The incremental cost-effectiveness ratio was $35 360/QALY (95% CI, $21 518-77 419), with a 90% chance of being cost-effective at a willingness-to-pay threshold of $50 000/QALY. A minimum mortality reduction of 28%, or a minimum duration of benefit of >1 to 2 years was required for catheter ablation to be attractive at this threshold. Conclusions Catheter ablation is likely to be cost-effective as a second line intervention for patients with HF with symptomatic atrial fibrillation, with incremental cost-effectiveness ratio $35 360/QALY, as long as over half of the relative mortality benefit observed in extant trials is borne out in future studies.
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Affiliation(s)
- Darren Lau
- Department of Medicine University of Alberta Edmonton AB Canada
| | - Roopinder K Sandhu
- Mazankowski Alberta Heart InstituteUniversity of Alberta Edmonton AB Canada.,Canadian VIGOUR Centre University of Alberta Edmonton AB Canada
| | - Jason G Andrade
- Division of Cardiology University of British Columbia Vancouver BC Canada
| | - Justin Ezekowitz
- Mazankowski Alberta Heart InstituteUniversity of Alberta Edmonton AB Canada.,Canadian VIGOUR Centre University of Alberta Edmonton AB Canada
| | - Helen So
- Department of Medicine University of Alberta Edmonton AB Canada
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15
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Ha ACT, Wijeysundera HC, Qiu F, Henning K, Ahmad K, Angaran P, Birnie DH, Crystal E, Ha AH, Healey JS, Leong-Sit P, Makanjee B, Nery PB, Redfearn DP, Skanes AC, Verma A. Differences in Healthcare Use Between Patients With Persistent and Paroxysmal Atrial Fibrillation Undergoing Catheter-Based Atrial Fibrillation Ablation: A Population-Based Cohort Study From Ontario, Canada. J Am Heart Assoc 2020; 10:e016071. [PMID: 33381975 PMCID: PMC7955473 DOI: 10.1161/jaha.120.016071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Patients with persistent atrial fibrillation (AF) undergoing catheter-based AF ablation have lower success rates than those with paroxysmal AF. We compared healthcare use and clinical outcomes between patients according to their AF subtypes. Methods and Results Consecutive patients undergoing AF ablation were prospectively identified from a population-based registry in Ontario, Canada. Via linkage with administrative databases, we performed a retrospective analysis comparing the following outcomes between patients with persistent and paroxysmal AF: healthcare use (defined as AF-related hospitalizations/emergency room visits), periprocedural complications, and mortality. Multivariable Poisson modeling was performed to compare the rates of AF-related and all-cause hospitalizations/emergency room visits in the year before versus after ablation. Between April 2012 and March 2016, there were 3768 consecutive patients who underwent first-time AF ablation, of whom 1040 (27.6%) had persistent AF. The mean follow-up was 1329 days. Patients with persistent AF had higher risk of AF-related hospitalization/emergency room visits (hazard ratio [HR], 1.21; 95% CI, 1.09-1.34), mortality (HR, 1.74; 95% CI, 1.15-2.63), and periprocedural complications (odds ratio, 1.36; 95% CI, 1.02-1.75) than those with paroxysmal AF. In the overall cohort, there was a 48% reduction in the rate of AF-related hospitalization/emergency room visits in the year after versus before ablation (rate ratio [RR], 0.52; 95% CI, 0.48-0.56). This reduction was observed for patients with paroxysmal (RR, 0.45; 95% CI, 0.41-0.50) and persistent (RR, 0.74; 95% CI, 0.63-0.87) AF. Conclusions Although patients with persistent AF had higher risk of adverse outcomes than those with paroxysmal AF, ablation was associated with a favorable reduction in downstream AF-related healthcare use, irrespective of AF type.
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Affiliation(s)
- Andrew C T Ha
- Department of Medicine University of Toronto Ontario Canada.,Peter Munk Cardiac CentreToronto General HospitalUniversity Health Network Toronto Ontario Canada
| | - Harindra C Wijeysundera
- Department of Medicine University of Toronto Ontario Canada.,Sunnybrook Health Sciences Centre Toronto Ontario Canada.,ICES Toronto Ontario Canada
| | | | | | - Kamran Ahmad
- Department of Medicine University of Toronto Ontario Canada.,St. Michael's HospitalUnity Health Toronto Toronto Ontario Canada
| | - Paul Angaran
- Department of Medicine University of Toronto Ontario Canada.,St. Michael's HospitalUnity Health Toronto Toronto Ontario Canada
| | - David H Birnie
- University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Eugene Crystal
- Department of Medicine University of Toronto Ontario Canada.,Sunnybrook Health Sciences Centre Toronto Ontario Canada
| | - Andrew H Ha
- Trillium Health Partners Mississauga Ontario Canada
| | - Jeff S Healey
- Department of Medicine Hamilton Health Sciences Population Health Research Institute McMaster University Hamilton Ontario Canada
| | - Peter Leong-Sit
- Division of Cardiology Western UniversityLondon Health Sciences Centre London Ontario Canada
| | | | - Pablo B Nery
- University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Damian P Redfearn
- Division of Cardiology Kingston General HospitalQueen's University Kingston Ontario Canada
| | - Allan C Skanes
- Division of Cardiology Western UniversityLondon Health Sciences Centre London Ontario Canada
| | - Atul Verma
- Department of Medicine University of Toronto Ontario Canada.,Southlake Regional Health Centre Newmarket Ontario Canada
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16
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Chew DS, Loring Z, Anand J, Fudim M, Lowenstern A, Rymer JA, Weimer KED, Atwater BD, DeVore AD, Exner DV, Noseworthy PA, Yancy CW, Mark DB, Piccini JP. Economic Evaluation of Catheter Ablation of Atrial Fibrillation in Patients with Heart Failure With Reduced Ejection Fraction. Circ Cardiovasc Qual Outcomes 2020; 13:e007094. [PMID: 33280436 DOI: 10.1161/circoutcomes.120.007094] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Randomized clinical trials have demonstrated that catheter ablation for atrial fibrillation in patients with heart failure with reduced ejection fraction may improve survival and other cardiovascular outcomes. METHODS We constructed a decision-analytic Markov model to estimate the costs and benefits of catheter ablation and medical management in patients with symptomatic heart failure with reduced ejection fraction (left ventricular ejection fraction ≤35%) and atrial fibrillation over a lifetime horizon. Evidence from the published literature informed the model inputs, including clinical effectiveness data from meta-analyses. Probabilistic and deterministic sensitivity analyses were performed. A 3% discount rate was applied to both future costs and benefits. The primary outcome was the incremental cost-effectiveness ratio assessed from the US health care sector perspective. RESULTS Catheter ablation was associated with 6.47 (95% CI, 5.89-6.93) quality-adjusted life years (QALYs) and a total cost of $105 657 (95% CI, $55 311-$191 934; 2018 US dollars), compared with 5.30 (95% CI, 5.20-5.39) QALYs and $63 040 (95% CI, $37 624-$102 260) for medical management. The incremental cost-effectiveness ratio for catheter ablation compared with medical management was $38 496 (95% CI, $5583-$117 510) per QALY gained. Model inputs with the greatest variation on incremental cost-effectiveness ratio estimates were the cost of ablation and the effect of catheter ablation on mortality reduction. When assuming a more conservative estimate of the treatment effect of catheter ablation on mortality (hazard ratio of 0.86), the estimated incremental cost-effectiveness ratio was $74 403 per QALY gained. At a willingness-to-pay threshold of $100 000 per QALY gained, atrial fibrillation ablation was found to be economically favorable compared with medical management in 95% of simulations. CONCLUSIONS Catheter ablation in patients with heart failure with reduced ejection fraction patients and atrial fibrillation may be considered economically attractive at current benchmarks for societal willingness-to-pay in the United States.
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Affiliation(s)
- Derek S Chew
- Duke Clinical Research Institute, Duke University, Durham, NC (D.S.C., Z.L., M.F., A.L., J.A.R., A.D.D., D.B.M., J.P.P.)
| | - Zak Loring
- Duke Clinical Research Institute, Duke University, Durham, NC (D.S.C., Z.L., M.F., A.L., J.A.R., A.D.D., D.B.M., J.P.P.).,Division of Cardiology (Z.L., M.F., A.L., J.A.R., B.D.A., A.D.D., D.B.M., J.P.P.), Duke University Medical Center, Durham, NC
| | - Jatin Anand
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery (J.A.), Duke University Medical Center, Durham, NC
| | - Marat Fudim
- Duke Clinical Research Institute, Duke University, Durham, NC (D.S.C., Z.L., M.F., A.L., J.A.R., A.D.D., D.B.M., J.P.P.).,Division of Cardiology (Z.L., M.F., A.L., J.A.R., B.D.A., A.D.D., D.B.M., J.P.P.), Duke University Medical Center, Durham, NC
| | - Angela Lowenstern
- Duke Clinical Research Institute, Duke University, Durham, NC (D.S.C., Z.L., M.F., A.L., J.A.R., A.D.D., D.B.M., J.P.P.).,Division of Cardiology (Z.L., M.F., A.L., J.A.R., B.D.A., A.D.D., D.B.M., J.P.P.), Duke University Medical Center, Durham, NC
| | - Jennifer A Rymer
- Duke Clinical Research Institute, Duke University, Durham, NC (D.S.C., Z.L., M.F., A.L., J.A.R., A.D.D., D.B.M., J.P.P.).,Division of Cardiology (Z.L., M.F., A.L., J.A.R., B.D.A., A.D.D., D.B.M., J.P.P.), Duke University Medical Center, Durham, NC
| | - Kristin E D Weimer
- Department of Pediatrics (K.E.D.W.), Duke University Medical Center, Durham, NC
| | - Brett D Atwater
- Division of Cardiology (Z.L., M.F., A.L., J.A.R., B.D.A., A.D.D., D.B.M., J.P.P.), Duke University Medical Center, Durham, NC
| | - Adam D DeVore
- Duke Clinical Research Institute, Duke University, Durham, NC (D.S.C., Z.L., M.F., A.L., J.A.R., A.D.D., D.B.M., J.P.P.).,Division of Cardiology (Z.L., M.F., A.L., J.A.R., B.D.A., A.D.D., D.B.M., J.P.P.), Duke University Medical Center, Durham, NC
| | - Derek V Exner
- Department of Cardiac Sciences, University of Calgary, Alberta, Canada (D.V.E.)
| | - Peter A Noseworthy
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (P.A.N.)
| | - Clyde W Yancy
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (C.W.Y.)
| | - Daniel B Mark
- Duke Clinical Research Institute, Duke University, Durham, NC (D.S.C., Z.L., M.F., A.L., J.A.R., A.D.D., D.B.M., J.P.P.).,Division of Cardiology (Z.L., M.F., A.L., J.A.R., B.D.A., A.D.D., D.B.M., J.P.P.), Duke University Medical Center, Durham, NC
| | - Jonathan P Piccini
- Duke Clinical Research Institute, Duke University, Durham, NC (D.S.C., Z.L., M.F., A.L., J.A.R., A.D.D., D.B.M., J.P.P.).,Division of Cardiology (Z.L., M.F., A.L., J.A.R., B.D.A., A.D.D., D.B.M., J.P.P.), Duke University Medical Center, Durham, NC
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17
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Chen JM, Zhong YT, Tu C, Lan J. Significance of serum fibroblast growth factor-23 and miR-208b in pathogenesis of atrial fibrillation and their relationship with prognosis. World J Clin Cases 2020; 8:3458-3464. [PMID: 32913852 PMCID: PMC7457118 DOI: 10.12998/wjcc.v8.i16.3458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/12/2020] [Accepted: 07/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The incidence and prevalence of atrial fibrillation are increasing each year, and this condition is one of the most common clinical arrhythmias.
AIM To investigate the levels and significance of serum fibroblast growth factor 23 (FGF-23) and miR-208b in patients with atrial fibrillation and their relationship with prognosis.
METHODS From May 2018 to October 2019, 240 patients with atrial fibrillation were selected as an observation group, including 134 with paroxysmal atrial fibrillation and 106 with persistent atrial fibrillation; 150 patients with healthy sinus rhythm were selected as a control group. The serum levels of FGF-23 and miR-208b in the two groups were measured. In the observation group, cardiac parameters were determined by echocardiography.
RESULTS The serum levels of FGF-23 and miR-208b in the observation group were 210.20 ± 89.60 ng/mL and 5.30 ± 1.22 ng/mL, which were significantly higher than the corresponding values in the control group (P < 0.05). In the observation group, the serum levels of FGF-23 and miR-208b in patients with persistent atrial fibrillation were 234.22 ± 70.05 ng/mL and 5.83 ± 1.00 ng/mL, which were significantly higher than the corresponding values in patients with paroxysmal atrial fibrillation (P < 0.05). The left atrial dimension (LAD) of patients with persistent atrial fibrillation was 38.81 ± 5.11 mm, which was significantly higher than that of patients with paroxysmal atrial fibrillation (P > 0.05). The serum levels of FGF-23 and miR-208b were positively correlated with the LAD (r = 0.411 and 0.382, P < 0.05). In the observation group, the serum levels of FGF-23 and miR-208b in patients with a major cardiovascular event (MACE) were 243.30 ± 72.29 ng/mL and 6.12 ± 1.12 ng/mL, which were significantly higher than the corresponding values in patients without a MACE (P < 0.05).
CONCLUSION The serum levels of FGF-23 and miR-208b are increased in patients with atrial fibrillation and are related to the type of disease, cardiac parameters, and prognosis.
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Affiliation(s)
- Jie-Min Chen
- Department of Cardiovascular Medicine, Dongguan Songshan Lake Central Hospital, Dongguan Institute of Cardiovascular Disease, Dongguan 523326, Guangdong Province, China
| | - Yao-Tang Zhong
- Department of Cardiovascular Medicine, Dongguan Songshan Lake Central Hospital, Dongguan Institute of Cardiovascular Disease, Dongguan 523326, Guangdong Province, China
| | - Chang Tu
- Department of Cardiovascular Medicine, Dongguan Songshan Lake Central Hospital, Dongguan Institute of Cardiovascular Disease, Dongguan 523326, Guangdong Province, China
| | - Jun Lan
- Department of Cardiovascular Medicine, Dongguan Songshan Lake Central Hospital, Dongguan Institute of Cardiovascular Disease, Dongguan 523326, Guangdong Province, China
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