Resource Use Following Atrial Fibrillation Ablation: Spending Resources to Save Resources

here is no question about the tremendous burden that atrial fibrillation (AF) places on patients with regard to quality of life, and this is undoubtedly impacted by frequent interaction with physicians and health care facilities. In turn, this cumulative effect generates a substantial burden on the health care system at large. 1 For some time, a prevailing hypothesis has been that deployment of the most effective treatment of AF, ablation, despite its resource intensiveness, may ultimately benefit patients and the system alike. In an attempt to explore this hypothesis in a real-world setting, Dhande et al evaluated health care resource use in this issue of the Journal of the American Heart Association (JAHA). Resources examined included hospitalizations, visits to emergency departments, cardioversions, stress tests, and echocardiograms. AF-related anticoagulant and antiarrhythmic prescriptions were also reported. These end points have the benefit of being relevant at the patient and system levels. The authors found that in the 2 years after AF ablation, on average, health care resource use decreased for every measure compared with the year before ablation. Unsurprisingly, this reduction in health care resource use, specifically reductions in AF hospitalizations and emergency department visits, translated to estimated cost savings of $8000 per patient per year compared with an estimated cost of (each) ablation of $21 500. These savings would be muted by repeated ablation, which would be expected in a significant minority of patients after AF ablation; in this series, that amounted to 10% of the cohort in the first 2 years following ablation.