Rhythm control may not be costlier than rate control

Strategies to control rhythm and control rate in patients with atrial fibrillation (AF) and heart failure (HF) do not differ significantly in terms of costs, according to a study published in the October issue of the Canadian Journal of Cardiology. The total per-patient costs were approximately $70,581 USD for rhythm control and $76,404 USD for rate-control.

Higher rhythm-related costs in some areas were offset by higher rate-related costs in other areas.

Using data from the Atrial Fibrillation and Congestive Heart Failure (AF-CHF) trial that compared the two types of strategies, researchers led by Frederic Poulin, MD, of Montreal Heart Institute, calculated costs of care among patients from Quebec for each of the treatment modalities. They included 304 patients, and both rhythm-control and rate-control patients were similar in baseline characteristics. For their cost data, they utilized a Quebec-wide insurance database, using 2009 Canadian dollars.

After more than 500 patient-years of follow-up, the authors found that rhythm-related costs made up 45 percent of total spending. Patients in the rate-control group underwent fewer cardiac procedures (predominantly cardioversions) and incurred lower antiarrhythmic drug costs ($46.56 USD vs $1,279.43 USD in the rhythm-control group).

“However, these differences were offset by higher expenditures due to hospitalizations for noncardiovascular diagnoses, implantable arrhythmia devices, and noncardiovascular drugs in the rate-control group,” the authors explained.

They argued that their findings call into question the previous hypothesis that controlling rhythm was a costlier strategy that involved more frequent hospitalizations for recurrent AF and cardioversions.

“We hypothesize that the more common use of pacemakers and cardioverter-defibrillators in the rate-control group during the study resulted from the more aggressive use of negative chronotropic agents in this group,” the authors wrote.

Their findings, they continued, “provide further justification for tailored therapy according to the clinical scenario."