Cost-Effectiveness and Clinical Effectiveness of the Risk Factor Management Clinic in Atrial Fibrillation: The CENT Study

Rajeev K. Pathak, Michelle Evans, Melissa E. Middeldorp, Rajiv Mahajan, Abhinav B. Mehta, Megan Meredith, Darragh Twomey, Christopher X. Wong, Jeroen M.L. Hendriks, Walter P. Abhayaratna, Jonathan M. Kalman, Dennis H. Lau, Prashanthan Sanders

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Abstract

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.

Original languageEnglish
Pages (from-to)436-447
Number of pages12
JournalJACC: Clinical Electrophysiology
Volume3
Issue number5
DOIs
Publication statusPublished - May 2017
Externally publishedYes

Keywords

  • ablation
  • atrial fibrillation
  • cost effectiveness
  • risk factor management

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    Pathak, R. K., Evans, M., Middeldorp, M. E., Mahajan, R., Mehta, A. B., Meredith, M., Twomey, D., Wong, C. X., Hendriks, J. M. L., Abhayaratna, W. P., Kalman, J. M., Lau, D. H., & Sanders, P. (2017). Cost-Effectiveness and Clinical Effectiveness of the Risk Factor Management Clinic in Atrial Fibrillation: The CENT Study. JACC: Clinical Electrophysiology, 3(5), 436-447. https://doi.org/10.1016/j.jacep.2016.12.015