Evidence map›Paper›PMID 33280436›Full record

ArticleCirculation. Cardiovascular quality and outcomes2020

Economic Evaluation of Catheter Ablation of Atrial Fibrillation in Patients with Heart Failure With Reduced Ejection Fraction.

Derek S Chew, Zak Loring, Jatin Anand, Marat Fudim, Angela Lowenstern, Jennifer A Rymer, Kristin E D Weimer, Brett D Atwater, Adam D DeVore, Derek V Exner and 4 more

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Circulation. Cardiovascular quality and outcomes, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

12 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
  2. Cost Effectiveness of Catheter Ablation Versus Antiarrhythmic Drugs for Atrial Fibrillation: A Systematic Review and Meta-analysis.American journal of cardiovascular drugs : drugs, devices, and other interventions · 2025
    Pooled it
  3. Guideline
  4. Guideline
  5. Trial
  6. Trial
  7. Review
  8. Article
  9. Article
  10. Article
  11. Article
  12. The economics of heart failure care.Progress in cardiovascular diseases
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Derek S ChewDuke Clinical Research Institute, Duke University, Durham, NC (D.S.C., Z.L., M.F., A.L., J.A.R., A.D.D., D.B.M., J.P.P.).
Zak LoringDuke Clinical Research Institute, Duke University, Durham, NC (D.S.C., Z.L., M.F., A.L., J.A.R., A.D.D., D.B.M., J.P.P.).
Jatin AnandDivision of Cardiovascular and Thoracic Surgery, Department of Surgery (J.A.), Duke University Medical Center, Durham, NC.
Marat FudimDuke Clinical Research Institute, Duke University, Durham, NC (D.S.C., Z.L., M.F., A.L., J.A.R., A.D.D., D.B.M., J.P.P.).
Angela LowensternDuke Clinical Research Institute, Duke University, Durham, NC (D.S.C., Z.L., M.F., A.L., J.A.R., A.D.D., D.B.M., J.P.P.).
Jennifer A RymerDuke Clinical Research Institute, Duke University, Durham, NC (D.S.C., Z.L., M.F., A.L., J.A.R., A.D.D., D.B.M., J.P.P.).
Kristin E D WeimerDepartment of Pediatrics (K.E.D.W.), Duke University Medical Center, Durham, NC.
Brett D AtwaterDivision of Cardiology (Z.L., M.F., A.L., J.A.R., B.D.A., A.D.D., D.B.M., J.P.P.), Duke University Medical Center, Durham, NC.
Adam D DeVoreDuke Clinical Research Institute, Duke University, Durham, NC (D.S.C., Z.L., M.F., A.L., J.A.R., A.D.D., D.B.M., J.P.P.).
Derek V ExnerDepartment of Cardiac Sciences, University of Calgary, Alberta, Canada (D.V.E.).
Peter A NoseworthyDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (P.A.N.).
Clyde W YancyDivision of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (C.W.Y.).
Daniel B MarkDuke Clinical Research Institute, Duke University, Durham, NC (D.S.C., Z.L., M.F., A.L., J.A.R., A.D.D., D.B.M., J.P.P.).
Jonathan P PicciniDuke Clinical Research Institute, Duke University, Durham, NC (D.S.C., Z.L., M.F., A.L., J.A.R., A.D.D., D.B.M., J.P.P.).

Funding

Postdoctoral Training in Cardiovascular Clinical ResearchT32HL069749 · NHLBI · DUKE UNIVERSITY · PI MARK, DANIEL B · 2003 to 2023
$6.7M
CIHRNHLBI NIH HHS T32 HL069749
6 · The paper itself

Abstract

backgroundRandomized clinical trials have demonstrated that catheter ablation for atrial fibrillation in patients with heart failure with reduced ejection fraction may improve survival and other cardiovascular outcomes.

methodsWe constructed a decision-analytic Markov model to estimate the costs and benefits of catheter ablation and medical management in patients with symptomatic heart failure with reduced ejection fraction (left ventricular ejection fraction ≤35%) and atrial fibrillation over a lifetime horizon. Evidence from the published literature informed the model inputs, including clinical effectiveness data from meta-analyses. Probabilistic and deterministic sensitivity analyses were performed. A 3% discount rate was applied to both future costs and benefits. The primary outcome was the incremental cost-effectiveness ratio assessed from the US health care sector perspective.

resultsCatheter ablation was associated with 6.47 (95% CI, 5.89-6.93) quality-adjusted life years (QALYs) and a total cost of $105 657 (95% CI, $55 311-$191 934; 2018 US dollars), compared with 5.30 (95% CI, 5.20-5.39) QALYs and $63 040 (95% CI, $37 624-$102 260) for medical management. The incremental cost-effectiveness ratio for catheter ablation compared with medical management was $38 496 (95% CI, $5583-$117 510) per QALY gained. Model inputs with the greatest variation on incremental cost-effectiveness ratio estimates were the cost of ablation and the effect of catheter ablation on mortality reduction. When assuming a more conservative estimate of the treatment effect of catheter ablation on mortality (hazard ratio of 0.86), the estimated incremental cost-effectiveness ratio was $74 403 per QALY gained. At a willingness-to-pay threshold of $100 000 per QALY gained, atrial fibrillation ablation was found to be economically favorable compared with medical management in 95% of simulations.

conclusionsCatheter ablation in patients with heart failure with reduced ejection fraction patients and atrial fibrillation may be considered economically attractive at current benchmarks for societal willingness-to-pay in the United States.

Indexed as

Health Care CostsStroke VolumeVentricular Function, LeftAnti-Arrhythmia AgentsAtrial FibrillationCatheter AblationCost-Benefit AnalysisDecision Support TechniquesDrug CostsHeart FailureHumansMarkov ChainsQuality-Adjusted Life YearsQuality of LifeTime FactorsTreatment OutcomeAnti-Arrhythmia Agentsatrial fibrillationcatheter ablationcosts and cost analysisheart failuremortalitysurvival

Identifiers

PMID33280436
PMCPMC7738404

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.