Risk Factor Management in Atrial Fibrillation

May 16, 2017
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Authors:
Pathak RV, Evans M, Middeldorp ME, et al.
Citation:
Cost-Effectiveness and Clinical Effectiveness of the Risk Factor Management Clinic in Atrial Fibrillation: The CENT Study. JACC Clin Electrophysiol 2017;3:436-447.
Summary By:
Fred Morady, MD, FACC

Study Questions:

How helpful and cost-effective is risk factor management (RFM) in patients with atrial fibrillation (AF)?

Methods:

Three hundred fifty-five patients with AF and a body mass index (BMI) ≥27 kg/m2 were offered aggressive RFM. Two hundred and eight patients accepted and formed the study group, while 147 patients who declined formed the control group. Physicians blinded to the study group managed the AF. Follow-up consisted of clinic visits every 3-6 months and 7-day Holter monitors. Outcomes included AF burden and cost-effectiveness of RFM.

Results:

There were no differences in baseline characteristics (mean age 59 years and mean BMI 33 kg/m2 in both groups) and the mean duration of follow-up was approximately 48 months in both groups. Weight loss in the RFM group averaged 10 kg compared with 3 kg in the control group. Freedom from AF was significantly higher in the RFM group (79%) than in the control group (44%). The need for hospitalizations, cardioversions, emergency department visits, ablation procedures, and antihypertensive and antiarrhythmic medications all were significantly lower in the RFM group. The cost saving was $12,094 and there was an increase of 0.1939 quality-adjusted life-years in the RFM group, yielding an incremental cost-effectiveness ratio of $62,653 per quality-adjusted life-years gained.

Conclusions:

An aggressive, structured RFM program reduces the AF burden and is cost-effective.

Perspective:

It is noteworthy that a mean incremental weight loss of only 7 kg in the RFM group was sufficient to result in an impressive reduction in AF burden, need for AF therapies, and cost. It is clear that aggressive RFM always should be part of the management strategy in overweight or obese patients with AF.

Keywords: Ambulatory Care, Anti-Arrhythmia Agents, Antihypertensive Agents, Arrhythmias, Cardiac, Atrial Fibrillation, Body Mass Index, Cost-Benefit Analysis, Cost Savings, Catheter Ablation, Emergency Service, Hospital, Obesity, Overweight, Quality-Adjusted Life Years, Risk Factors, Secondary Prevention, Treatment Outcome, Weight Loss


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