What is the clinical evidence from this study?

Study design: RCT. Population: recovered atrial fibrillation-mediated cardiomyopathy. Intervention: HFrEF pharmacotherapy withdrawal vs. continuation. Primary outcome: In-trial medication cost (MD -1031, p=<0.001).

What does this research mean for the field?

In patients with recovered atrial fibrillation-mediated cardiomyopathy after ablation, withdrawal of heart failure pharmacotherapy achieves cost-minimization without negatively impacting functional capacity or quality of life. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To assess the economic impact and cost-effectiveness of withdrawing heart failure pharmacotherapy in patients with recovered atrial fibrillation-mediated cardiomyopathy following catheter ablation.

September 29, 2026International Journal of Cardiology

Cost-effectiveness of heart failure pharmacotherapy withdrawal in recovered atrial fibrillation mediated cardiomyopathy: analysis of the WITHDRAW-AF randomized clinical trial

Q: What are the key findings of this study?

HFrEF pharmacotherapy withdrawal reduced in-trial medication costs by $1031 per patient ($1572 vs $2604, p<0.001) without detriment to functional status or quality of life.

Q: What does this research mean for the field?

In patients with recovered atrial fibrillation-mediated cardiomyopathy after ablation, withdrawal of heart failure pharmacotherapy achieves cost-minimization without negatively impacting functional capacity or quality of life. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To assess the economic impact and cost-effectiveness of withdrawing heart failure pharmacotherapy in patients with recovered atrial fibrillation-mediated cardiomyopathy following catheter ablation.

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Key result

HFrEF pharmacotherapy withdrawal reduces medication costs ~$1031 without compromising functional status or quality of life.

MD -1031
P<0.001

Why the study?

The economic implications of withdrawing HFrEF pharmacotherapy in patients with recovered atrial fibrillation-mediated cardiomyopathy post-ablation were not previously examined.

Key Points

To assess the economic impact and cost-effectiveness of withdrawing heart failure pharmacotherapy in patients with recovered atrial fibrillation-mediated cardiomyopathy following catheter ablation.
Evaluated within-trial healthcare costs and projected 5-year expenditures using a Markov model parameterized by the WITHDRAW-AF randomized clinical trial.
Measured functional capacity using VO2max and the 6-minute walk test (6MWT), alongside quality-of-life assessments using the MLHFQ mapped to EQ-5D-5L utilities across 2,000 Monte Carlo probabilistic simulations.
In-trial medication cost savings reached $1,031 per patient ($1,572 vs $2,604, p < 0.001), with projected 5-year costs of $3,901 (95% CI: $3,852–$3,950) for withdrawal versus $8,446 (95% CI: $8,375–$8,517) for continuation.
Functional outcomes favored drug withdrawal in the majority of simulations: 6MWT distance improved in 61.8% of runs (difference 29.39 m, 95% CI: 23.03–35.74), VO2max in 68.1% (difference 4.02 ml/kg/min, 95% CI: 3.49–4.44), and MLHFQ scores in 53.7% (difference 1.71, 95% CI: 0.57–2.84).
Quality-adjusted life years (QALYs) were equivalent between treatment arms, showing a minimal difference of 0.003 (95% CI: -0.05 to 0.01).

Study Design

Type

RCT

PICO

Population

Patients with recovered atrial fibrillation-mediated cardiomyopathy post-ablation evaluated for cost-effectiveness of HFrEF pharmacotherapy withdrawal.

Intervention / Comparator

HFrEF pharmacotherapy withdrawal vs continuation

Primary Outcome

In-trial medication cost — MD -1031, p=<0.001

Main Result

Mean Difference: -1031

Absolute Event Rate: 1572% vs 2604%

p-value: p=<0.001

Implication

May support deprescribing HFrEF therapy in selected post-ablation patients; extends RCT safety data with economic modeling.

Abstract

BACKGROUND: The WITHDRAW-AF trial demonstrated HFrEF pharmacotherapy can be safely withdrawn in carefully selected patients with recovered atrial fibrillation-mediated cardiomyopathy post-ablation. In this study, we examined the economic implications of this strategy. METHODS: We compared costs and outcomes of each strategy during the trial and through a 5-year Markov model. Functional status was assessed by VO2max and 6-min walk test distance (6MWT), and quality of life by the Minnesota Living with Heart Failure Questionnaire (MLHFQ) mapped to the EQ-5D-5L. Probabilistic sensitivity analysis was through 2000 Monte Carlo simulations. RESULTS: In-trial medication cost savings were $1031/patient ($1572 vs $2604, p < 0.001). Over 5 years, projected modelled costs for withdrawal versus continuation were $3901 (95% CI: $3852-$3950) versus $8446 (95% CI: $8375-$8517). Outcomes favoured withdrawal; 6MWT in 61.8% of simulations (difference 29.39 m, 95% CI: 23.03-35.74), VO2max in 68.1% (difference 4.02 ml/kg/min, 95% CI: 3.49-4.44), and MLHFQ in 53.7% (difference 1.71, 95% CI: 0.57-2.84). QALYs were comparable (difference 0.003, 95% CI: -0.05-0.01). CONCLUSION: In recovered atrial fibrillation-mediated cardiomyopathy, HFrEF pharmacotherapy withdrawal represented cost-minimisation without detriment to functional status or quality of life.

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Cite This Study

Cho et al. (2026) conducted an RCT in recovered atrial fibrillation-mediated cardiomyopathy. HFrEF pharmacotherapy withdrawal vs. continuation was evaluated on In-trial medication cost (MD -1031, p=<0.001). HFrEF pharmacotherapy withdrawal reduced in-trial medication costs by $1031 per patient ($1572 vs $2604, p<0.001) without detriment to functional status or quality of life.

synapsesocial.com/papers/6abb0675077501092874c067 https://doi.org/10.1016/j.ijcard.2026.134943