Cost-effectiveness of targeting patients undergoing cardiac surgery for therapy with intravenous amiodarone to prevent atrial fibrillation.
OBJECTIVE
This study evaluated the cost-effectiveness of administering prophylactic intravenous (IV) amiodarone therapy to patients undergoing cardiac surgery according to their predicted risk of postoperative atrial fibrillation.


BACKGROUND
Atrial fibrillation (AF) is a common complication of cardiovascular surgery that is associated with a significant increase in hospitalization costs. Intravenous amiodarone has been shown to decrease the incidence of postoperative AF.


METHODS
All 8,709 patients who underwent coronary artery bypass grafting (CABG), 1,217 patients who underwent valve replacement and 624 patients who underwent CABG and valve replacement procedures (CABG + valve) from January 1, 1994, to June 30, 1999, at Emory University Hospitals were studied. Models predicting the risk of AF were developed using logistic regression; linear regression was used to estimate the influence of AF on hospitalization costs. Cost-effectiveness was evaluated for patient subsets identified according to their predicted risk of AF.


RESULTS
Postoperative AF rates were 17.7% for CABG, 24.6% for valve and 33.8% for CABG + valve. Using 5,000 dollars as an acceptable cost per episode of atrial fibrillation averted, prophylactic IV amiodarone in CABG patients was not found to be cost-effective. Therapy would be recommended for roughly 5% of valve patients with a predicted risk of atrial fibrillation >45%, and roughly two thirds of CABG + valve patients who have a predicted risk of >30%.


CONCLUSIONS
Cost-effectiveness of prophylactic IV amiodarone varies according to type of surgery and the predicted risk of atrial fibrillation. Older patients undergoing valve replacement, particularly those with a history of chronic obstructive pulmonary disease, and those undergoing concomitant CABG are likely to be the most appropriate candidates for IV amiodarone therapy in the perioperative period.
Division of Cardiology, Department of Medicine, Emory University, Atlanta, Georgia, USA. emahone@emory.edu
Elizabeth M
EM
Mahoney
Trevor D
TD
Thompson
Emir
E
Veledar
Jovonne
J
Williams
William S
WS
Weintraub
D000368:Aged; D000638:Amiodarone / Q000191:economics* / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000191:economics* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000191:economics / Q000517:prevention & control*; D001026:Coronary Artery Bypass / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000191:economics*; D017721:Hospital Costs; D006801:Humans; D007262:Infusions, Intravenous; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000517:prevention & control*
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone