Catheter Ablation Versus Antiarrhythmic Medication in Patients with Atrial Fibrillation: a Propensity-Matched Analysis Based on a German Claims Data Set

Abstract

Aims: Main objective of our analysis was to assess the long-term clinical and health economics outcomes of catheter ablation versus antiarrhythmic medication therapy in Germany. Methods: We conducted a retrospective analysis of anonymized claims data covering the years 2010-2014. Patients with at least one diagnosis of AF and a minimum follow-up period of twelve months (excluding death) were included and assigned into two treatment groups: AF ablation and antiarrhythmic medication. To balance different patient characteristics in both groups, the final analysis was based on propensity score-matched (PSM) cohorts. Results: Of 498,253 AF patients, 2,404 could be assigned to the final analysis population – 1,202 patients in each group. The difference in the all-cause mortality rate reached statistical significance after 24 months of observation (1.5% versus 3.1% (p=0.015)) and after 36 months (1.7% versus 4.8% (p=0.005)). We could not identify any significant difference between the groups in cardiovascular events (amongst others stroke, TIA, myocardial infarction) over the three-year observation period. Direct cardiology-associated healthcare costs after index date (excluding catheter ablation procedure) were significantly different between the groups in the first and third observational year (third-year costs of €1,618 in the ablation group versus €2,462 in the medication group; p<0.007). Conclusion: Over a period of 36 months, all-cause mortality in AF patients who underwent catheter ablation was found to be significantly lower compared to AF patients who received antiarrhythmic medication. Direct cardiology healthcare costs after the ablation procedure proved to be consistently and significantly lower in comparison with medication therapy.