Stroke and Cardiovascular Events After Ablation or Antiarrhythmic Drugs for Treatment of Patients With Atrial Fibrillation
Catheter ablation and antiarrhythmic drugs (AADs) are the most common rhythm-control strategies for atrial fibrillation (AF). Data comparing the rate of stroke and cardiovascular events between the treatment strategies are limited. Therefore, this observational study uses claims data to compare rate...
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description | Catheter ablation and antiarrhythmic drugs (AADs) are the most common rhythm-control strategies for atrial fibrillation (AF). Data comparing the rate of stroke and cardiovascular events between the treatment strategies are limited. Therefore, this observational study uses claims data to compare rate of cardiovascular hospitalization and stroke for patients with AF treated with ablation or AADs. Patients in the MarketScan dataset with AF between January 2010 and December 2014 were categorized in the ablation group if an atrial catheter ablation was performed, or in the AAD group if a relevant AAD was prescribed for AF but no ablation was performed. One year of history was required, and the index event was selected as the most recent ablation or AAD prescription closest to January 1, 2013. A 2:1 propensity score match was performed for age, gender, co-morbidities, and total medical cost in the year before index event. Outcomes included thromboembolic event (ischemic stroke, transient ischemic attack, or systemic embolism) and all cardiovascular hospitalizations. Of the 164,639 patients in the AAD group, 29,456 were matched to the 14,728 ablation patients. There were no significant differences in age (64 ± 10 in both groups), gender (58% male), or CHA2DS2-VASc score (3.2 ± 1.3). Risk of hospitalization with primary diagnosis of thromboembolic event was 41% greater in the AADs group (p |
doi_str_mv | 10.1016/j.amjcard.2018.01.043 |
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Kevin ; Agarwal, Rahul ; Bunch, T. Jared ; Karst, Edward ; Ruskin, Jeremy N. ; Mahapatra, Srijoy</creator><creatorcontrib>Mansour, Moussa ; Heist, E. Kevin ; Agarwal, Rahul ; Bunch, T. Jared ; Karst, Edward ; Ruskin, Jeremy N. ; Mahapatra, Srijoy</creatorcontrib><description>Catheter ablation and antiarrhythmic drugs (AADs) are the most common rhythm-control strategies for atrial fibrillation (AF). Data comparing the rate of stroke and cardiovascular events between the treatment strategies are limited. Therefore, this observational study uses claims data to compare rate of cardiovascular hospitalization and stroke for patients with AF treated with ablation or AADs. Patients in the MarketScan dataset with AF between January 2010 and December 2014 were categorized in the ablation group if an atrial catheter ablation was performed, or in the AAD group if a relevant AAD was prescribed for AF but no ablation was performed. One year of history was required, and the index event was selected as the most recent ablation or AAD prescription closest to January 1, 2013. A 2:1 propensity score match was performed for age, gender, co-morbidities, and total medical cost in the year before index event. Outcomes included thromboembolic event (ischemic stroke, transient ischemic attack, or systemic embolism) and all cardiovascular hospitalizations. Of the 164,639 patients in the AAD group, 29,456 were matched to the 14,728 ablation patients. There were no significant differences in age (64 ± 10 in both groups), gender (58% male), or CHA2DS2-VASc score (3.2 ± 1.3). Risk of hospitalization with primary diagnosis of thromboembolic event was 41% greater in the AADs group (p < 0.001), and cardiovascular hospitalizations were 13% more likely (p < 0.001). In conclusion, patients treated with catheter ablation of AF have lower risk of thromboembolic events and cardiovascular hospitalizations than a matched cohort of patients managed with AADs.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2018.01.043</identifier><identifier>PMID: 29571722</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Ablation ; Aged ; Aged, 80 and over ; Anti-Arrhythmia Agents - therapeutic use ; Antiarrhythmics ; Anticoagulants ; Anticoagulants - therapeutic use ; Arrhythmia ; Atrial Fibrillation - complications ; Atrial Fibrillation - therapy ; Cardiac arrhythmia ; Cardiovascular Diseases - epidemiology ; Catheter Ablation ; Catheters ; Cohort Studies ; Drugs ; Embolism ; Female ; Fibrillation ; Health risks ; Hospitalization ; Humans ; Insurance coverage ; Ischemia ; Ischemic Attack, Transient - epidemiology ; Ischemic Attack, Transient - etiology ; Ischemic Attack, Transient - prevention & control ; Low density lipoprotein ; Male ; Medical instruments ; Middle Aged ; Patients ; Retrospective Studies ; Stroke ; Stroke - epidemiology ; Stroke - etiology ; Stroke - prevention & control ; Thromboembolism ; Thromboembolism - epidemiology ; Thromboembolism - etiology ; Thromboembolism - prevention & control ; Transient ischemic attack</subject><ispartof>The American journal of cardiology, 2018-05, Vol.121 (10), p.1192-1199</ispartof><rights>2018 The Authors</rights><rights>Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.</rights><rights>2018. The Authors</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c440t-c04f44177d978c81a8040fdb87371063dda609b037d2306524a3df0adc62c0fc3</citedby><cites>FETCH-LOGICAL-c440t-c04f44177d978c81a8040fdb87371063dda609b037d2306524a3df0adc62c0fc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002914918301875$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29571722$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mansour, Moussa</creatorcontrib><creatorcontrib>Heist, E. Kevin</creatorcontrib><creatorcontrib>Agarwal, Rahul</creatorcontrib><creatorcontrib>Bunch, T. Jared</creatorcontrib><creatorcontrib>Karst, Edward</creatorcontrib><creatorcontrib>Ruskin, Jeremy N.</creatorcontrib><creatorcontrib>Mahapatra, Srijoy</creatorcontrib><title>Stroke and Cardiovascular Events After Ablation or Antiarrhythmic Drugs for Treatment of Patients With Atrial Fibrillation</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Catheter ablation and antiarrhythmic drugs (AADs) are the most common rhythm-control strategies for atrial fibrillation (AF). Data comparing the rate of stroke and cardiovascular events between the treatment strategies are limited. Therefore, this observational study uses claims data to compare rate of cardiovascular hospitalization and stroke for patients with AF treated with ablation or AADs. Patients in the MarketScan dataset with AF between January 2010 and December 2014 were categorized in the ablation group if an atrial catheter ablation was performed, or in the AAD group if a relevant AAD was prescribed for AF but no ablation was performed. One year of history was required, and the index event was selected as the most recent ablation or AAD prescription closest to January 1, 2013. A 2:1 propensity score match was performed for age, gender, co-morbidities, and total medical cost in the year before index event. Outcomes included thromboembolic event (ischemic stroke, transient ischemic attack, or systemic embolism) and all cardiovascular hospitalizations. Of the 164,639 patients in the AAD group, 29,456 were matched to the 14,728 ablation patients. There were no significant differences in age (64 ± 10 in both groups), gender (58% male), or CHA2DS2-VASc score (3.2 ± 1.3). Risk of hospitalization with primary diagnosis of thromboembolic event was 41% greater in the AADs group (p < 0.001), and cardiovascular hospitalizations were 13% more likely (p < 0.001). In conclusion, patients treated with catheter ablation of AF have lower risk of thromboembolic events and cardiovascular hospitalizations than a matched cohort of patients managed with AADs.</description><subject>Ablation</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Arrhythmia Agents - therapeutic use</subject><subject>Antiarrhythmics</subject><subject>Anticoagulants</subject><subject>Anticoagulants - therapeutic use</subject><subject>Arrhythmia</subject><subject>Atrial Fibrillation - complications</subject><subject>Atrial Fibrillation - therapy</subject><subject>Cardiac arrhythmia</subject><subject>Cardiovascular Diseases - epidemiology</subject><subject>Catheter Ablation</subject><subject>Catheters</subject><subject>Cohort Studies</subject><subject>Drugs</subject><subject>Embolism</subject><subject>Female</subject><subject>Fibrillation</subject><subject>Health risks</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Insurance coverage</subject><subject>Ischemia</subject><subject>Ischemic Attack, Transient - epidemiology</subject><subject>Ischemic Attack, Transient - etiology</subject><subject>Ischemic Attack, Transient - prevention & control</subject><subject>Low density lipoprotein</subject><subject>Male</subject><subject>Medical instruments</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Stroke</subject><subject>Stroke - epidemiology</subject><subject>Stroke - etiology</subject><subject>Stroke - prevention & control</subject><subject>Thromboembolism</subject><subject>Thromboembolism - epidemiology</subject><subject>Thromboembolism - etiology</subject><subject>Thromboembolism - prevention & control</subject><subject>Transient ischemic attack</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkUtv1DAUhS0EokPhJ4AssWGTcP1InKzQaNoCUiWQKGJpOX4wDklcbGek8utxOwMLNqxsy9859-ochF4SqAmQ9u1Yq3nUKpqaAulqIDVw9ghtSCf6ivSEPUYbAKBVT3h_hp6lNJYnIU37FJ3RvhFEULpBv77kGH5YrBaDd8XNh4NKep1UxJcHu-SEty7biLfDpLIPCw7lvmSvYtzf5f3sNb6I6_eEXfm4iVbluahwcPhz4R8Mvvm8x9scvZrwlR-in45Wz9ETp6ZkX5zOc_T16vJm96G6_vT-4257XWnOIVcauOOcCGF60emOqA44ODN0ggkCLTNGtdAPwIShDNqGcsWMA2V0SzU4zc7Rm6PvbQw_V5uynH3Stmyx2LAmeZ8fsBJVX9DX_6BjWONStisUA8GgaWihmiOlY0gpWidvo59VvJME5H05cpSnch7MJRBZyim6Vyf3dZit-av600YB3h0BW-I4eBtl0iVDbY2PVmdpgv_PiN-y3qLe</recordid><startdate>20180515</startdate><enddate>20180515</enddate><creator>Mansour, Moussa</creator><creator>Heist, E. 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Kevin</au><au>Agarwal, Rahul</au><au>Bunch, T. Jared</au><au>Karst, Edward</au><au>Ruskin, Jeremy N.</au><au>Mahapatra, Srijoy</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Stroke and Cardiovascular Events After Ablation or Antiarrhythmic Drugs for Treatment of Patients With Atrial Fibrillation</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2018-05-15</date><risdate>2018</risdate><volume>121</volume><issue>10</issue><spage>1192</spage><epage>1199</epage><pages>1192-1199</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><abstract>Catheter ablation and antiarrhythmic drugs (AADs) are the most common rhythm-control strategies for atrial fibrillation (AF). Data comparing the rate of stroke and cardiovascular events between the treatment strategies are limited. Therefore, this observational study uses claims data to compare rate of cardiovascular hospitalization and stroke for patients with AF treated with ablation or AADs. Patients in the MarketScan dataset with AF between January 2010 and December 2014 were categorized in the ablation group if an atrial catheter ablation was performed, or in the AAD group if a relevant AAD was prescribed for AF but no ablation was performed. One year of history was required, and the index event was selected as the most recent ablation or AAD prescription closest to January 1, 2013. A 2:1 propensity score match was performed for age, gender, co-morbidities, and total medical cost in the year before index event. Outcomes included thromboembolic event (ischemic stroke, transient ischemic attack, or systemic embolism) and all cardiovascular hospitalizations. Of the 164,639 patients in the AAD group, 29,456 were matched to the 14,728 ablation patients. There were no significant differences in age (64 ± 10 in both groups), gender (58% male), or CHA2DS2-VASc score (3.2 ± 1.3). Risk of hospitalization with primary diagnosis of thromboembolic event was 41% greater in the AADs group (p < 0.001), and cardiovascular hospitalizations were 13% more likely (p < 0.001). In conclusion, patients treated with catheter ablation of AF have lower risk of thromboembolic events and cardiovascular hospitalizations than a matched cohort of patients managed with AADs.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>29571722</pmid><doi>10.1016/j.amjcard.2018.01.043</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Ablation Aged Aged, 80 and over Anti-Arrhythmia Agents - therapeutic use Antiarrhythmics Anticoagulants Anticoagulants - therapeutic use Arrhythmia Atrial Fibrillation - complications Atrial Fibrillation - therapy Cardiac arrhythmia Cardiovascular Diseases - epidemiology Catheter Ablation Catheters Cohort Studies Drugs Embolism Female Fibrillation Health risks Hospitalization Humans Insurance coverage Ischemia Ischemic Attack, Transient - epidemiology Ischemic Attack, Transient - etiology Ischemic Attack, Transient - prevention & control Low density lipoprotein Male Medical instruments Middle Aged Patients Retrospective Studies Stroke Stroke - epidemiology Stroke - etiology Stroke - prevention & control Thromboembolism Thromboembolism - epidemiology Thromboembolism - etiology Thromboembolism - prevention & control Transient ischemic attack |
title | Stroke and Cardiovascular Events After Ablation or Antiarrhythmic Drugs for Treatment of Patients With Atrial Fibrillation |
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