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European Heart Journal 2004 25(17):1542-1549; doi:10.1016/j.ehj.2004.06.020
Copyright © 2004 by the European Society of Cardiology.
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Clinical research

Rate control is more cost-effective than rhythm control for patients with persistent atrial fibrillation — results from the RAte Control versus Electrical cardioversion (RACE) study

Vincent E. Hagensa, Karin M. Vermeulenb, Elisabeth M. TenVergertb, Dirk J. Van Veldhuisena, Hans A. Boskerc, Otto Kampd, J. Herre Kingmae, Jan G.P. Tijssenf, Harry J.G.M. Crijnsg and Isabelle C. Van Geldera,* for the RAte Control versus Electrical cardioversion for persistent atrial fibrillation study group

a Department of Cardiology, Thoraxcenter, University Hospital Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands
b Office for Medical Technology Assessment, University Hospital, Groningen, The Netherlands
c Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
d Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
e Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
f Department of Cardiology, Academical Medical Center, Amsterdam, The Netherlands
g Department of Cardiology, University Hospital, Maastricht, The Netherlands

Received April 7, 2004; revised June 2, 2004; accepted June 10, 2004 * Corresponding author. Tel.: +31-50-3612355; fax: +31-50-3614391 (E-mail: i.c.van.gelder{at}thorax.azg.nl).

Aims To evaluate costs between a rate and rhythm control strategy in persistent atrial fibrillation.

Methods and results In a prospective substudy of RACE (Rate control versus electrical cardioversion for persistent atrial fibrillation) in 428 of the total 522 patients (206 rate control and 222 rhythm control), a cost-minimisation and cost-effectiveness analysis was performed to assess cost-effectiveness of the treatment strategies.

After a mean follow-up of 2.3±0.6 years, the primary endpoint (cardiovascular morbidity and mortality) occurred in 17.5% (36/202) of the rate control patients and in 21.2% (47/222) of the rhythm control patients. Mean costs per patient under rate control were {euro} 7386 and {euro} 8284 under rhythm control. Cost-effectiveness analysis showed that per avoided endpoint under rate control, the cost savings were {euro} 24944. Under rhythm control, more costs were generated due to electrical cardioversions, hospital admissions and anti-arrhythmic medication. Costs were higher in older patients, patients with underlying heart disease, those who reached a primary endpoint and women. Heart rhythm at the end of study, did not influence costs.

Conclusions Rate control is more cost-effective than rhythm control for treatment of persistent atrial fibrillation. Underlying heart disease but not heart rhythm largely accounts for costs.


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