Trends in US hospitalization rates and rhythm control therapies following publication of the AFFIRM and RACE trials

Abstract

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.

Figure 1

U.S. hospital discharges with AF as principal diagnosis, by source of admission, 1998–2006.

Figure 2

Year-over-year change in U.S. hospital discharges with AF as principal diagnosis, by source of admission, 1998–2006.

Figure 3

U.S. hospital discharges with AF as principal diagnosis, 1998–2006, stratified by patient and hospital characteristics. A: By patient age; B: By payer; C: By hospital teaching status; D: By hospital location.

Figure 3

U.S. hospital discharges with AF as principal diagnosis, 1998–2006, stratified by patient and hospital characteristics. A: By patient age; B: By payer; C: By hospital teaching status; D: By hospital location.

Figure 3

U.S. hospital discharges with AF as principal diagnosis, 1998–2006, stratified by patient and hospital characteristics. A: By patient age; B: By payer; C: By hospital teaching status; D: By hospital location.

Figure 3

U.S. hospital discharges with AF as principal diagnosis, 1998–2006, stratified by patient and hospital characteristics. A: By patient age; B: By payer; C: By hospital teaching status; D: By hospital location.

Figure 4

U.S. principal procedure electrical cardioversions and catheter ablations with AF as the principal diagnosis and with all other principal diagnoses, 2001–2006.

Figure 5

Dispensed oral antiarrhythmic drug prescriptions through U.S. retail and mail pharmacies, 1998–2006. (Source: National Prescription Audit^™, January 1998 – December 2006, IMS Health Incorporated. All Rights Reserved.)