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Updated: Aug 16, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Healthcare Utilization and Outcomes in Atrial Fibrillation Patients Treated by Drug Therapy versus a Catheter
Martin Martinek1,2, Harry J G M Crijns2, Barbara A B Essers2
1Internal Medicine II with Cardiology, Angiology, and Intensive Care Medicine, Ordensklinikum Linz Elisabethinen, 4020 Linz, Austria.
Insights
Percutaneous coronary intervention (PVI) for atrial fibrillation (AF) increases healthcare costs but significantly reduces mortality and improves employment rates. Further cost-efficiency improvements are needed for PVI procedures.
Area of Science:
- Cardiology
- Health Economics
Background:
- Atrial fibrillation (AF) is a common arrhythmia with significant mortality, morbidity, and healthcare costs.
- Treatment options include catheter ablation (PVI) and drug-based rhythm or rate control (non-PVI).
Purpose of the Study:
- To compare the long-term economic and clinical outcomes of PVI versus non-PVI strategies for atrial fibrillation.
- To evaluate the societal impact of different AF treatment approaches.
Main Methods:
- Analysis of inpatient and outpatient data from the Upper Austrian Health Insurance Fund (2005-2018).
- Inclusion of patients with a first AF hospitalization.
- Propensity score matching (PSM) using CHA 2 DS2 -VASc variables and working "collar" to create comparable groups.
Main Results:
- 1013 well-matched pairs (PVI vs. non-PVI) identified from 21,791 AF patients.
- PVI strategy associated with higher annual expenditures (€2200/year).
- PVI group showed a 5.1 pp higher employment rate and 7.6 pp fewer retirements.
- Significant 5.8 pp reduction in all-cause mortality over 10 years with PVI.
Conclusions:
- PVI treatment increases healthcare expenditures compared to drug therapy alone, primarily due to procedure costs.
- Higher employment rates with PVI offer significant societal benefits.
- PVI strategy demonstrates a substantial reduction in all-cause mortality, attributed to the procedure, improved risk management, and adherence.
Background And Aims:
Atrial fibrillation (AF) is the most prevalent arrhythmia, associated with increased mortality and morbidity and causing relevant costs. Treatment options consist of catheter ablation (PVI) and rate or rhythm control drugs (non-PVI).
Methods:
We analyze inpatient and outpatient data from the Upper Austrian Health Insurance Fund. Data of patients with a first hospitalization for AF in the years 2005 to 2018 were examined, using propensity score matching (PSM) including all CHA2DS2-VASc variables and working "collar".
Results:
Out of 21,791 AF patients, PSM identified 1013 well-matching pairs (PVI and non-PVI). Over a ten-year period, the PVI treatment strategy group reveals significantly higher inpatient and outpatient expenditures (€2200/year). Positive economic effects can be demonstrated by a 5.1 percentage points (pp) higher employment rate and fewer retirements (7.6pp). Of utmost important is the 5.8pp all-cause mortality reduction over 10 years in the PVI treatment strategy.
Conclusions:
A PVI based treatment strategy results in higher healthcare expenditures vs. drug therapy alone. Most of these higher costs were caused by the PVI procedures during this period. Thus, more effective and efficient methods are needed to further reduce costs for the intervention and prevent repeat procedures. The benefit of a PVI treatment strategy is seen in higher employment rates, which are crucial from a societal perspective and should be a strong argument for caregivers. We show a significant reduction in all-cause mortality, which we partly attribute to the PVI procedure itself, to a stricter risk factor assessment and treatment, and a tighter medical adherence.
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