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Published on: February 26, 2013
Cost-Effectiveness and Clinical Effectiveness of the Risk Factor Management Clinic in Atrial Fibrillation: The CENT
Rajeev K Pathak1, Michelle Evans1, Melissa E Middeldorp1
1Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
Insights
Integrating risk factor management (RFM) into atrial fibrillation (AF) care significantly improves patient outcomes and reduces healthcare costs. This approach leads to better arrhythmia-free survival and substantial cost savings.
Area of Science:
- Cardiology
- Health Economics
Background:
- Atrial fibrillation (AF) presents a significant economic burden on healthcare systems.
- Weight and risk factor management (RFM) is known to reduce AF burden and enhance AF ablation success rates.
Purpose of the Study:
- To assess the clinical effectiveness and cost-efficiency of incorporating RFM into the comprehensive management of AF patients.
- To quantify the impact of RFM on patient outcomes and healthcare resource utilization.
Main Methods:
- A cohort of 355 patients with symptomatic AF and BMI ≥27 kg/m² was studied.
- 208 patients underwent RFM, while 147 served as controls, with follow-up including clinic reviews, Holter monitoring, and symptom scoring.
- A decision-analytical model determined incremental cost-effectiveness ratios based on global well-being and AF burden reduction.
Main Results:
- The RFM group demonstrated significantly better arrhythmia-free survival (79% vs. 44%, p < 0.001).
- RFM led to fewer unplanned specialist visits, hospitalizations, cardioversions, emergency presentations, and ablation procedures.
- Significant reductions in antihypertensive and antiarrhythmic medication use were observed in the RFM group.
Conclusions:
- Physician-directed RFM programs are clinically effective in managing AF.
- Implementing RFM strategies results in significant cost savings for the healthcare system.
Background:
Atrial fibrillation (AF) imposes a substantial cost burden on the healthcare system. Weight and risk factor management (RFM) reduces AF burden and improves the outcomes of AF ablation.
Objectives:
This study sought to evaluate the cost and clinical effectiveness of integrating RFM into the overall management of AF.
Methods:
Of 1,415 consecutive patients with symptomatic AF, 825 patients had body mass index ≥27 kg/m2. After screening for exclusion criteria, the final cohort comprised 355 patients: 208 patients who opted for RFM and 147 control subjects and were followed by 3 to 6 monthly clinic review, 7-day Holter monitoring, and AF Symptom Score. A decision analytical model calculated the incremental cost-effectiveness ratios of cost per unit of global well-being gained and unit of AF burden reduced.
Results:
There were no differences in baseline characteristics or follow-up duration (p = NS). Arrhythmia-free survival was better in the RFM compared with control subjects (Kaplan-Meier: 79% vs. 44%; p < 0.001). At follow-up, RFM group had less unplanned specialist visits (0.19 ± 0.40 vs. 1.94 ± 2.00; p < 0.001), hospitalizations (0.74 ± 1.3 vs. 1.05 ± 1.60; p = 0.03), cardioversions (0.89 ± 1.50 vs. 1.51 ± 2.30; p = 0.002), emergency presentations (0.18 ± 0.50 vs. 0.76 ± 1.20; p < 0.001), and ablation procedures (0.60 ± 0.69 vs. 0.72 ± 0.86; p = 0.03). Antihypertensive (0.53 ± 0.70 vs. 0.78 ± 0.60; p = 0.04) and antiarrhythmic (0.26 ± 0.50 vs. 0.91 ± 0.60; p = 0.003) use declined in RFM. The RFM group had an increase of 0.1930 quality-adjusted life years and a cost saving of $12,094 (incremental cost-effectiveness ratios of $62,653 saved per quality-adjusted life years gained).
Conclusions:
A structured physician-directed RFM program is clinically effective and cost saving.
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