PO-01-069 HEART FAILURE INCIDENCE AMONG PATIENTS WITH ATRIAL FIBRILLATION TREATED WITH ANTI-ARRHYTHMIC DRUGS VERSUS CATHETER ABLATION: RETROSPECTIVE ANALYSIS OF AN ADMINISTRATIVE CLAIMS DATABASE OF COMMERCIALLY INSURED POPULATION IN THE UNITED STATES

Abstract

Atrial fibrillation (AF) considerably increases the risk of heart failure (HF). While the risk of hospitalization of heart failure and mortality are known in the setting of atrial fibrillation, effective treatment of AF could potentially alleviate the risk of HF development. We compared the incidence of heart failure among patients with AF treated with catheter ablation (CA) versus anti-arrhythmic drugs (AAD). 2014-2022 Optum Clinformatics database for commercially insured and Medicare Advantage beneficiaries in the United States was utilized for patients (aged 19 years and above) with AF and history of one AAD usage. Patients were then classified into two cohorts – those who had CA (CA cohort) versus those who had a different AAD prescription (AAD cohort) between 2014 and 2022. Exclusion criteria included history of HF, prior valvular procedure, pacemaker or implantable cardioverter defibrillator, surgical ablation, or left atrial appendage occlusion. The two study cohorts were matched on socio-demographic and clinical covariates using a propensity score technique. Cox regression model was used to examine the differential risk of incident HF in the two cohorts. Sub-analyses were performed by race/ethnicity and sex, respectively. After propensity matching, 10,462 patients were identified in each of the two study cohorts (AAD and CA). Patients treated with CA had 56% lower risk of incident HF as compared to those treated with AADs (hazard ratio [HR] 0.44; 95% CI 0.41-0.47). Sub-analysis by race/ethnicity depicted similarly consistent results, with White (HR 0.43; 95% CI 0.40-0.46), Black (HR 0.42; 95% CI 0.33-0.54), Hispanic (HR 0.49; 95% CI 0.38-0.63), and Asian (HR 0.29; 95% CI 0.15-0.55) patients, respectively. When examining by sex, female patients treated with CA (HR 0.46; 95% CI 0.42-0.50) and male patients treated with CA (HR 0.40; 95% CI 0.36-0.44) had significantly lower risk of incident HF compared to female and male patients, respectively, treated with AAD. Patients with AF treated with CA were observed to have significantly lower risk of development of HF as compared to those treated with AAD, with a 56% overall reduction in incidence of HF. The lower risk of HF associated with CA versus AAD was consistent across different race/ethnic and sex categories.