Dr. Reynolds was supported in part by award K23 HL077171 from NHLBI. Dr. Essebag is the recipient of a Clinician Scientist Award from the Canadian Institute of Health Research (CIHR).
Trends in US Hospitalization Rates and Rhythm Control Therapies Following Publication of the AFFIRM and RACE Trials
Article first published online: 18 NOV 2010
© 2010 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 22, Issue 5, pages 548–553, May 2011
How to Cite
MARTIN-DOYLE, W., ESSEBAG, V., ZIMETBAUM, P. and REYNOLDS, M. R. (2011), Trends in US Hospitalization Rates and Rhythm Control Therapies Following Publication of the AFFIRM and RACE Trials. Journal of Cardiovascular Electrophysiology, 22: 548–553. doi: 10.1111/j.1540-8167.2010.01950.x
Dr. Reynolds has received research grants and consulting fees from Biosense Webster and Sanofi Aventis. Dr. Essebag has received honoraria from Biosense Webster, Sanofi Aventis, Medtronic Inc., and Bayer.
The statements, findings, conclusions, views, and opinions contained and expressed in this manuscript are based in part on data obtained under license from the following IMS Health Incorporated information service(s): National Prescription Audit™ (1998–2006), IMS Health Incorporated. All rights reserved. Such statements, findings, conclusions, views, and opinions are not necessarily those of IMS Health Incorporated or any of its affiliated or subsidiary entities.
- Issue published online: 11 MAY 2011
- Article first published online: 18 NOV 2010
- Manuscript received 19 August 2010; Revised manuscript received 27 September 2010; Accepted for publication 1 October 2010.
- atrial fibrillation;
- antiarrhythmic drug;
- catheter ablation;
Trends in US Hospitalization Rates and Rhythm Control. Introduction: 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.
Methods and Results: 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.
Conclusion: 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. (J Cardiovasc Electrophysiol, Vol. 22, pp. 548-553 May 2011)