is an employee of, and Diana Frame and Peter J. Mallow are consultants of, CTI Clinical Trial and Consulting Services, which is a consultant to Biosense Webster, the study sponsor. Mark M. Gallagher has received research funding from Attune Medical and has acted as a consultant and paid speaker for Boston Scientific and Cook Medical. Lisa W. M. Leung has received research support from Attune Medical.

Atrial fibrillation (AF) ablation is most commonly performed using radiofrequency (RF) and cryoballoon (CB) catheters. Ablation Index is a novel lesion-quality marker associated with improved outcomes in RF ablation. Due to lack of direct comparative evidence between the latest generations of technologies, there is uncertainty regarding the best treatment option. Aim: To conduct a network meta-analysis to evaluate the comparative effectiveness of RF with Ablation Index to other catheter ablation devices in the treatment of AF. Methods: Searches for randomized and nonrandomized prospective comparative studies of ablation catheters were conducted in multiple databases. The outcome of interest was 12-month freedom from atrial arrhythmias after a single ablation procedure. Studies were grouped as high-, low- and unclear-quality based on study design and balanced baseline patient characteristics. Bayesian hierarchical network meta-analysis was conducted and results presented as relative risk ratios with 95% credible intervals (CrIs). Results: 12 studies evaluating five different catheter ablation devices were included. Radiofrequency ablation with Ablation Index was associated with statistically significantly greater probability of 12-month freedom from atrial arrhythmias than Arctic Front (relative risk: 1.77; 95% CrI: 1.21–2.87), Arctic Front Advance™ (1.41; 1.06–2.47), THERMOCOOL™ (1.34; 1.17–1.48) and THERMOCOOL SMARTTOUCH™ (1.09; 1–1.3). Results were robust in multiple sensitivity analyses. Conclusion: Radiofrequency catheter with Ablation Index is superior to currently available options for 12-month freedom from atrial arrhythmias after AF ablation. This study provides decision-makers with robust, pooled, comparative evidence of the latest ablation technologies.

Atrial fibrillation (AF), the most common form of arrhythmia, is fast becoming one of the world’s most significant health issues. It is well established that AF increases the risk of mortality, and is associated with significant morbidity, including an increased risk of stroke. AF also worsens quality of life for patients, which can also be a burden for caregivers. As a result of Europe’s ageing population, the prevalence of AF is expected to rise substantially in the future. With more patients expected to be affected by AF, rates for AF-related strokes, hospitalisations, and doctor visits are also expected to rise, ultimately raising healthcare system costs across Europe. It is estimated that up to 2.6% of total annual healthcare expenditure is associated with AF in European countries. The high cost of AF is largely attributable to hospitalisations and complications such as stroke, i.e., in 2015, stroke was estimated to cost €45 billion a year in the European Union (EU). The purpose of this review is to highlight the current scale and growing burden of this new millennium epidemic in Europe. This review aims to foster a greater awareness and understanding of the magnitude of the clinical, patient, and economic burden of AF. An understanding of the burden of AF is imperative for directing care pathway management and healthcare policies that can help alleviate the burden of AF experienced by patients, caregivers, and healthcare systems in Europe.

A245minutes at teaching hospitals and 175 minutes at non-teaching hospitals. There were significant variations in duration of routine ED visits across race groups at teaching and non-teaching hospitals. The risk-adjusted results show that the mean duration of routine ED visits for black/African American and Asian patients when compared to visits for white patients was shorter by 10.0 and 3.4 percent, respectively, at teaching hospitals; and longer by 3.6 and 13.8 percent, respectively, at non-teaching hospitals. Hispanic patients experienced 8.7 percent longer ED stays when compared to white patients at non-teaching hospitals. CONCLUSIONS: There is significant racial disparity in the duration of routine ED visits, especially in non-teaching hospitals where non-white patients experience longer ED stays compared to white patients. The variation in duration of routine ED visits at teaching hospitals when compared to non-teaching hospitals was smaller across race groups.

were identified and followed for 12 months after drug usage. Ttest, Chi-square test, binomial regression and generalized linear model adjusting for baseline demographics, cardiovascular events, inpatient days, and healthcare resource consumption were used to test the difference between two groups. RESULTS: A total of 439 patients were identified as using salvianolate injection (treatment group) and 1848 patients as control group (CHD or angina pectoris patients not using salvianolate injection), with mean (SD) age 75.4 (12.1) and 69.2 (12.8) (p<0.001) and male 43.3% and 52.4% (p<0.001), respectively. During the one-year baseline, the mean frequency of cardiovascular events were 2.1 and 5.8 times for treatment and control group respectively (p<0.001); the treatment cost for cardiovascular event were 4720.0 Chinese Yuan (CNY) and 3700.2 CNY for treatment and control group respectively (p¼0.11). During the follow-up period, after adjusting for baseline covariates, the average number of cardiovascular events were 0.3 and 5.9 times for treatment and control group respectively(p<0.001). Compared with non user, mean per-year cost for salvianolate injection user was 29.6% lower (4069.2 vs 5778.2 CNY). Compared with non user, mean per-year outpatient cost for salvianolate injection user was 74.2 vs 7400.1 CNY for non-user (p<0.001); while mean per-year inpatient cost for salvianolate injection user was 2858.8 vs 1468.3 CNY for non-user (p¼0.593). CONCLUSIONS: Among Chinese coronary heart disease or angina pectoris patients, those who used salvianolate injection had lower per-year cardiovascular event rate and spent less.