title: Atrial fibrillation and congestive heart failure: a cost analysis of rhythm-control vs. rate-control strategies.
abstract: BACKGROUND
  Atrial fibrillation (AF) is common in patients with heart failure. Rhythm- and rate-control strategies are associated with similar efficacy outcomes. We compared the economic impact of the 2 treatment strategies in patients with AF and heart failure from the province of Québec, Canada.
  
  
  METHODS
  In a substudy of the Atrial Fibrillation and Congestive Heart Failure trial, health care expenditures of patients from Québec randomized to rhythm and rate-control treatment strategies were compared from a single-payer perspective using a cost-minimization approach. In-trial resource utilization and unit costs were estimated from Québec Health Insurance Board databases supplemented by disease-specific costs from the Ontario Case Costing Initiative.
  
  
  RESULTS
  In all, 304 patients were included, aged 68 ± 9 years; 86% male; ejection fraction, 26% ± 6%. Baseline characteristics were similar in rhythm-control (n = 149) and rate-control (n = 155) groups. Arrhythmia-related costs accounted for 45% of total expenditures. Rate-control patients had fewer cardiac procedures (146 vs. 238, P < 0.001), driven by fewer cardioversions, and lower costs related to antiarrhythmic drugs (CAD $48 per patient [95% confidence interval {CI}, $21-$96] vs. $1319 per patient [95% CI, $1124-$1522]). However, these differences were offset by higher expenditures due to hospitalizations for noncardiovascular diagnoses, implantable cardiac arrhythmia devices, and noncardiovascular drugs in the rate-control group. The total cost per patient was not significantly different between rhythm-control ($72,764 [95% CI, $61,575-$85,145]) and rate-control ($78,767 [95% CI, $67,101-$92,139]) strategies.
  
  
  CONCLUSIONS
  In the study population, the therapeutic strategy used to manage AF in patients with severe heart failure appears to have little influence on the overall financial burden, which remains substantial.
authors.affiliation: Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Poulin
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
authors.forename: Denis
authors.initials: D
authors.lastname: Roy
authors.forename: Sylvie
authors.initials: S
authors.lastname: Levesque
authors.forename: Mario
authors.initials: M
authors.lastname: Talajic
authors.forename: Jason R
authors.initials: JR
authors.lastname: Guertin
authors.forename: Jacques
authors.initials: J
authors.lastname: Lelorier
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000191:economics / Q000628:therapy*; D002317:Cardiovascular Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004554:Electric Countershock / Q000191:economics*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000191:economics / Q000628:therapy*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011792:Quebec
chemical_list: D002317:Cardiovascular Agents