Abstract
BackgroundThe objective of our study was to compare resource use and clinical outcomes among atrial fibrillation (AF) patients who underwent catheter ablation versus antiarrhythmic drug (AAD) treatment.MethodsA retrospective cohort design using the Clinical Practice Research Data-Hospital Episode Statistics linkage data from England (2008–2013) was used. Patients undergoing catheter ablation treatment for AF were indexed to the date of first procedure. AAD patients with at least two different AAD drugs were indexed to the first fill of the second AAD. Patients were matched using 1:1 propensity matching. Primary endpoints including inpatient and outpatient visits were compared between ablation and AAD cohorts in the 4 months-1 year period after index. Secondary endpoints including heart failure, stroke, cardioversion, mortality, and a composite outcome were compared for the 4 months-3 years post-index period in the two groups. Cox-proportional hazards models were estimated for clinical outcomes comparison.ResultsA total of 558 patients were matched in the two groups for resource utilization comparison. The average number of cardiovascular (CV)-related outpatient visits in the 4–12 months post-index period were significantly lower in the ablation group versus the AAD group (1.76 vs 3.57, p < .0001). There was no significant difference in all-cause and CV-related inpatient visits and all-cause outpatient visits among the two groups. For secondary endpoints comparison, 615 matched patients in each group emerged. Ablation patients had 38% lower risk of heart failure (hazard ratio [HR] 0.62, p = 0.0318), 50% lower risk of mortality (HR 0.50, p = 0.0082), and 43% lower risk of experiencing a composite outcome (HR 0.57, p = 0.0009) as compared to AAD treatment cohort.ConclusionAF ablation was associated with significantly lower CV-related outpatient visits, and lower risk of heart failure and mortality versus AAD therapy.
Highlights
The objective of our study was to compare resource use and clinical outcomes among atrial fibrillation (AF) patients who underwent catheter ablation versus antiarrhythmic drug (AAD) treatment
For the secondary outcomes assessment, where patients were followed for a period of three years, a total of 1528 patients in the ablation cohort and 927 patients in the AAD cohort emerged as part of the pre-match sample
Using one of the largest nationally representative databases in the United Kingdom (UK), our study provided insights into a shortand long-term outcomes comparison between ablation and AAD treatment among patients with AF
Summary
The objective of our study was to compare resource use and clinical outcomes among atrial fibrillation (AF) patients who underwent catheter ablation versus antiarrhythmic drug (AAD) treatment. Undertreatment is the result of multiple factors, including improper assessment, over-estimation of the risk of bleeding and Jarman et al BMC Cardiovascular Disorders (2018) 18:211 underestimation of the risk of stroke. Retrospective cohort studies using large databases have found significantly lower rate of stroke and other adverse outcomes associated with AF ablation as compared to other treatment alternatives including AAD drugs [14, 17]. Jarman et al (2017) found significantly lower rates of stroke among AF patients undergoing ablation procedure as compared to AF patients who did not have an ablation or had cardioversion [15]
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