Related Experiment Video

Updated: Aug 5, 2025

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

33.5K

Cost-effectiveness of early rhythm control vs. usual care in atrial fibrillation care: an analysis based on data from

Sophie Gottschalk1, Shinwan Kany2,3, Hans-Helmut König1

  • 1Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistraße 52 Building W37, 20246 Hamburg, Germany.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|March 26, 2023
PubMed

Insights

Early rhythm control (ERC) in atrial fibrillation patients is cost-effective, offering significant health benefits at reasonable costs. The probability of ERC being cost-effective is high at a willingness-to-pay threshold of €55,000 per life year gained.

Area of Science:

  • Cardiology
  • Health Economics

Background:

  • The EAST-AFNET 4 trial demonstrated that early rhythm control (ERC) reduces major adverse cardiovascular outcomes by approximately 20%.
  • The cost-effectiveness of implementing ERC compared to usual care requires thorough evaluation from a healthcare system perspective.

Purpose of the Study:

  • To assess the cost-effectiveness of early rhythm control (ERC) versus usual care for patients with atrial fibrillation.
  • To determine the incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves (CEACs) for ERC.

Main Methods:

  • A within-trial cost-effectiveness analysis using data from the German subsample of the EAST-AFNET 4 trial (n=1664).
  • Evaluation from a healthcare payer's perspective over a 6-year time horizon, considering hospitalization and medication costs.
  • Calculation of ICERs for 'year without a primary outcome' and 'life year gained', alongside CEACs to address uncertainty.

Main Results:

  • Early rhythm control (ERC) was associated with higher costs (+€1924) compared to usual care.
  • ICERs were calculated at €10,638 per additional year without a primary outcome and €22,536 per life year gained.
  • Cost-effectiveness acceptability curves indicated a high probability (≥95% or ≥80%) of ERC being cost-effective at a willingness-to-pay of ≥€55,000.

Conclusions:

  • Early rhythm control (ERC) offers potential health benefits at reasonable costs from a German healthcare payer's perspective.
  • Cost-effectiveness of ERC is highly probable, particularly at willingness-to-pay thresholds of €55,000 or more.
  • Further research is recommended to explore ERC cost-effectiveness in diverse international settings, specific patient subgroups, and varying treatment modalities.
Abstract

Keywords:
Atrial fibrillationCost-effectivenessEarly rhythm control

More Related Videos

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation23:33

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

Published on: February 28, 2012

83.7K
Reduced Procedure Time and Variability with Active Esophageal Cooling During Radiofrequency Ablation for Atrial Fibrillation04:58

Reduced Procedure Time and Variability with Active Esophageal Cooling During Radiofrequency Ablation for Atrial Fibrillation

Published on: August 25, 2022

2.3K

Related Concept Videos

Dysrhythmias VI: Management of Dysrhythmias01:25

Dysrhythmias VI: Management of Dysrhythmias

Dysrhythmia management involves a multifaceted approach, incorporating pharmacological treatments, medical procedures, surgical interventions, lifestyle modifications, and patient education.Pharmacological ManagementAntiarrhythmic Drugs:Class I (Sodium Channel Blockers): This class includes quinidine and procainamide, which reduce the speed of impulse conduction in the heart, stabilize the cardiac membrane, and control arrhythmias. Quinidine and procainamide are Class IA agents that prolong the...
21
Disturbances in Heart Rhythm01:29

Disturbances in Heart Rhythm

Arrhythmia or dysrhythmia refers to an abnormal heart rhythm caused by a defect in the heart's conduction system. It can cause the heart to beat irregularly, too quickly, or too slowly, leading to symptoms like chest pain, shortness of breath, and fainting. Factors such as stress, caffeine, alcohol, nicotine, cocaine, certain drugs, congenital defects, diseases, and electrolyte abnormalities can trigger arrhythmias.
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...
1.1K
Dysrhythmias VII: Nursing Management of Dysrhythmias01:25

Dysrhythmias VII: Nursing Management of Dysrhythmias

Nursing management of dysrhythmias involves the following:AssessmentSubjective Assessment:The initial step involves gathering patient-reported symptoms such as dizziness, palpitations, and chest discomfort. It is crucial to collect a detailed history, including previous heart conditions, current medication use, and lifestyle factors like caffeine and alcohol consumption.Objective Assessment:This involves observing clinical signs such as jugular venous distention, cool and pale skin, and...
19
ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias01:25

ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias

Arrhythmia is a condition characterized by an irregular heart rhythm, with ECG changes that differ based on its origin and nature. The types of arrhythmias discussed below include atrial, junctional, and ventricular arrhythmias.Atrial ArrhythmiasPremature Atrial Complexes (PACs): PACs are early atrial beats caused by stress, caffeine, alcohol, electrolyte imbalances, hypoxia, hyperthyroidism, or certain medications (e.g., bronchodilators and decongestants). The ECG shows early P waves with an...
60
Pulse rhythm01:30

Pulse rhythm

Pulse rhythm refers to the pattern of pulsations within specific intervals, offering valuable insights into the regularity or irregularity of the heart's beats as observed through the pattern of pulsation within specific intervals. A regular pulse exhibits a consistent heart rate with uniform waveforms and pulsation force, variations of which can be classified as normal, weak, or bounding.
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac...
864
Dysrhythmias V: Evaluating Dysrhythmias01:30

Dysrhythmias V: Evaluating Dysrhythmias

Dysrhythmias, also known as arrhythmias, are disturbances in the heart's rhythm that range from benign to life-threatening. A thorough evaluation is crucial for appropriate management and involves a comprehensive medical history, physical examination, and various diagnostic tests.Medical HistorySymptoms: Collect detailed information on palpitations, dizziness, syncope, chest pain, and fatigue. Note their onset, frequency, and triggers.Previous Cardiac Issues: Document any history of heart...
43