Catheter ablation is recommended as a cost-effective second-line intervention for heart failure (HF) patients patients with symptomatic atrial fibrillation (AFib), according to new findings published in the Journal of the American Heart Association. It is also associated with a lower risk of adverse outcomes.
Using data from available randomized controlled trials and meta‐analyses, lead author Darren Lau, MD, PhD, of the University of Alberta and colleagues performed a cost‐utility analysis of catheter ablation compared to typical medical therapy of AFib in patients with HF.
"Current guidelines recommend catheter ablation in patients with HF with symptomatic AFib," the authors wrote. "The American Heart Association gives a IIb recommendation that select patients may benefit from lower mortality and reduced HF hospitalization, while the Canadian Cardiovascular Society recommends it in symptomatic patients after an adequate trial of antiarrhythmic therapy. Our results support both guidelines by showing that catheter ablation is likely cost‐effective.
The team found that EP Lab catheter ablation for HF patients with AFib refractory to first‐line medical management is cost-effective, with an incremental cost‐effectiveness ratio of $35,360 Canadian dollars/quality‐adjusted life‐years (QALY).
According to the authors, a minimum relative mortality reduction of 28% over at least 2 years is needed for catheter ablation to be cost-effective at a threshold of $50,000 Canadian dollars/QALY.
“Readers should avoid extrapolating these findings to patient groups that were not included in the randomized effectiveness trials, and more data on the effectiveness of catheter ablation compared with continued medical management, particularly on mortality and quality of life benefit, and in alternative patient populations, is needed,” Lau and colleagues concluded.
Read the full analysis here.