房颤患者消融治疗与抗心律失常药物治疗的资源利用及临床结局
Resource use and clinical outcomes in patients with atrial fibrillation with ablation versus antiarrhythmic drug treatment.
作者信息
Jarman Julian W E, Hussain Wajid, Wong Tom, Markides Vias, March Jamie, Goldstein Laura, Liao Ray, Kalsekar Iftekhar, Chitnis Abhishek, Khanna Rahul
机构信息
Heart Rhythm Centre, NIHR Cardiovascular Research Unit, The Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College, London, UK.
Franchise Health Economics and Market Access, Johnson & Johnson, Irvine, CA, USA.
出版信息
BMC Cardiovasc Disord. 2018 Nov 7;18(1):211. doi: 10.1186/s12872-018-0946-6.
BACKGROUND
The objective of our study was to compare resource use and clinical outcomes among atrial fibrillation (AF) patients who underwent catheter ablation versus antiarrhythmic drug (AAD) treatment.
METHODS
A retrospective cohort design using the Clinical Practice Research Data-Hospital Episode Statistics linkage data from England (2008-2013) was used. Patients undergoing catheter ablation treatment for AF were indexed to the date of first procedure. AAD patients with at least two different AAD drugs were indexed to the first fill of the second AAD. Patients were matched using 1:1 propensity matching. Primary endpoints including inpatient and outpatient visits were compared between ablation and AAD cohorts in the 4 months-1 year period after index. Secondary endpoints including heart failure, stroke, cardioversion, mortality, and a composite outcome were compared for the 4 months-3 years post-index period in the two groups. Cox-proportional hazards models were estimated for clinical outcomes comparison.
RESULTS
A total of 558 patients were matched in the two groups for resource utilization comparison. The average number of cardiovascular (CV)-related outpatient visits in the 4-12 months post-index period were significantly lower in the ablation group versus the AAD group (1.76 vs 3.57, p < .0001). There was no significant difference in all-cause and CV-related inpatient visits and all-cause outpatient visits among the two groups. For secondary endpoints comparison, 615 matched patients in each group emerged. Ablation patients had 38% lower risk of heart failure (hazard ratio [HR] 0.62, p = 0.0318), 50% lower risk of mortality (HR 0.50, p = 0.0082), and 43% lower risk of experiencing a composite outcome (HR 0.57, p = 0.0009) as compared to AAD treatment cohort.
CONCLUSION
AF ablation was associated with significantly lower CV-related outpatient visits, and lower risk of heart failure and mortality versus AAD therapy.
背景
我们研究的目的是比较接受导管消融术与抗心律失常药物（AAD）治疗的心房颤动（AF）患者的资源使用情况和临床结局。
方法
采用回顾性队列设计，使用来自英格兰的临床实践研究数据-医院事件统计链接数据（2008 - 2013年）。接受AF导管消融治疗的患者以首次手术日期为索引。使用至少两种不同AAD药物的AAD患者以第二种AAD的首次用药为索引。患者采用1:1倾向匹配法进行匹配。比较索引后4个月至1年期间消融组和AAD组的主要终点，包括住院和门诊就诊情况。比较两组索引后4个月至3年期间的次要终点，包括心力衰竭、中风、复律、死亡率和综合结局。采用Cox比例风险模型进行临床结局比较。
结果
两组共匹配558例患者进行资源利用比较。索引后4至12个月期间，消融组心血管（CV）相关门诊就诊的平均次数显著低于AAD组（1.76对3.57，p <.0001）。两组全因和CV相关住院就诊以及全因门诊就诊无显著差异。对于次要终点比较，每组出现615例匹配患者。与AAD治疗组相比，消融患者发生心力衰竭的风险降低38%（风险比[HR] 0.62，p = 0.0318），死亡风险降低50%（HR 0.50，p = 0.0082），发生综合结局的风险降低43%（HR 0.57，p = 0.0009）。
结论
与AAD治疗相比，AF消融术与显著更低的CV相关门诊就诊次数以及更低的心力衰竭和死亡风险相关。
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