Trends in US Hospitalization Rates and Rhythm Control Therapies Following Publication of the AFFIRM and RACE Trials

University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Journal of Cardiovascular Electrophysiology (Impact Factor: 2.96). 11/2010; 22(5):548-53. DOI: 10.1111/j.1540-8167.2010.01950.x
Source: PubMed


The impact of trials comparing rate versus rhythm control for AF on subsequent use of rhythm control therapies and hospitalizations at a national level has not been described.
We queried the Healthcare Cost & Utilization Project on the frequency of hospital admissions and performance of specific rhythm control procedures from 1998-2006. We analyzed trends in hospitalization for AF as principal diagnosis before and after the publication of key rate versus rhythm trials in 2002. We also reviewed the use of electrical cardioversion and catheter ablation as principal procedures during hospital admissions for any cause and for AF as principal diagnosis. We additionally appraised the overall outpatient utilization of antiarrhythmic drugs during this same time frame using IMS Health's National Prescription Audit.™ Admissions for AF as a principal diagnosis increased at 5%/year from 1998-2002. Following publication of the AFFIRM and RACE trials in 2002, admissions declined by 2%/year from 2002-2004, before rising again from 2004-2006. In-hospital electrical cardioversion followed a similar pattern. National prescription volumes for antiarrhythmic drugs grew at <1% per year from 2002 to 2006, with a marked decline in the use of class I-A agents, while catheter ablations during admissions for AF as the principal diagnosis increased at 30% per year.
The use of rhythm control therapies in the US declined significantly in the first few years after publication of AFFIRM and RACE. This trend reversed by 2005, at which time rapid growth in the use of catheter ablation for AF was observed.

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    ABSTRACT: Over the last decade, several rhythm-versus rate-control trails in patients with atrial fibrillation (AF) have failed to demonstrate benefit of the rhythm control strategy with respect to mortality and morbidity. This had let to the guideline recommendation that antiarrhythmic drug therapy should be considered predominantly for symptomatic improvement of patients. Recent trails and meta-analyses have demonstrated that amiodarone is the most antiarrhythmic drug currently available. However, its use has been associated with many adverse effects. Currently, dronedarone is the only available antiarrhythmic drug which has shown a reduction in cardiovascular hospitalizations in medium-risk AF patients. However, the drug was associated with increased mortality in patients with recently decompensated heart failure. Hence, antiarrhythmic drug therapy has to be evaluated in patients with AF on an individual patients basis.
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