Following publication of the AFFIRM and RACE trials, US hospital admissions for AF declined by 2%/year from 2002-2004 before rising again, alongside a 30%/year increase in catheter ablations.
Observational
Yes
Did the publication of the AFFIRM and RACE trials affect US hospitalization rates and the use of rhythm control therapies for AF?
The publication of the AFFIRM and RACE trials temporarily decreased the use of rhythm control therapies and AF hospitalizations in the US, followed by a resurgence driven by rapid growth in catheter ablation.
INTRODUCTION: The impact of trials comparing rate versus rhythm control for AF on subsequent use of rhythm control therapies and hospitalizations at a national level has not been described. METHODS AND RESULTS: We queried the Healthcare Cost & Utilization Project on the frequency of hospital admissions and performance of specific rhythm control procedures from 1998-2006. We analyzed trends in hospitalization for AF as principal diagnosis before and after the publication of key rate versus rhythm trials in 2002. We also reviewed the use of electrical cardioversion and catheter ablation as principal procedures during hospital admissions for any cause and for AF as principal diagnosis. We additionally appraised the overall outpatient utilization of antiarrhythmic drugs during this same time frame using IMS Health's National Prescription Audit.™ Admissions for AF as a principal diagnosis increased at 5%/year from 1998-2002. Following publication of the AFFIRM and RACE trials in 2002, admissions declined by 2%/year from 2002-2004, before rising again from 2004-2006. In-hospital electrical cardioversion followed a similar pattern. National prescription volumes for antiarrhythmic drugs grew at <1% per year from 2002 to 2006, with a marked decline in the use of class I-A agents, while catheter ablations during admissions for AF as the principal diagnosis increased at 30% per year. CONCLUSION: The use of rhythm control therapies in the US declined significantly in the first few years after publication of AFFIRM and RACE. This trend reversed by 2005, at which time rapid growth in the use of catheter ablation for AF was observed.
Martin‐Doyle et al. (Thu,) conducted a observational in Atrial fibrillation. Publication of AFFIRM and RACE trials vs. Pre-publication trends (1998-2002) was evaluated on Trends in hospitalization for AF as principal diagnosis and use of rhythm control therapies. Following publication of the AFFIRM and RACE trials, US hospital admissions for AF declined by 2%/year from 2002-2004 before rising again, alongside a 30%/year increase in catheter ablations.
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