Trends in Utilization of Management Strategies for Newly Diagnosed Atrial Fibrillation Patients in the United States

Abstract

Objective To describe the trend in atrial fibrillation (AF) treatment strategies in newly diagnosed AF patients between 1999 and 2008. Methods The study was a retrospective cohort study of commercial health plans claims data. Newly diagnosed adult AF patients with ≥1 claim for an AF-related intervention within 12 months of diagnosis were identified. Based on initial treatment, patients were classified into pharmacotherapy or nonpharmacotherapy groups. Pharmacotherapy group was subcategorized into rate-control or rhythm-control groups. Linear regression to assess linear trend and multinomial logistic regression to evaluate factors associated with treatment choice were conducted. Results Three thousand ninety-four newly diagnosed AF patients were identified. Eighty percent of these patients were initiated on pharmacotherapy with the majority (84%) receiving rate-control medications only. Relative distribution of the 3 treatment groups remained similar over the study period. However, within the rate-control group, the use of beta blockers increased significantly (P < .001). Treatment with nonpharmacotherapy over rate-control medications was higher in males but lower in patients aged ≥80 (relative risk ratio [RRR]: 1.67, 95% confidence interval [CI]: 1.27–2.20 and RRR: 0.48, 95% CI: 0.30–0.77, respectively). Having stroke and congestive heart failure significantly affected the treatment choice between nonpharmacotherapy and rate-control medications. Conclusion Medication therapy, especially rate-control strategies, remains the preferred initial therapy of choice.

Adherence to guideline recommendations for antiarrhythmic drugs in atrial fibrillation

“…Drug use in subgroups of patients with other heart diseases was not assessed. 26–28 In one of these studies, Class Ic drugs were the most commonly prescribed AADs in patients who were aged <60 years, indicating that these drugs may be preferred in younger patients with seemingly less concomitant heart disease. 26 Therefore, the results of our study provide the most detailed and contemporary picture of current AAD use in younger AF patients in the United States and have identified several areas of concern that warrant further investigation to improve care.…”

Evaluation of practice patterns in the treatment of atrial fibrillation among the commercially insured

“…Earlier analyses of practice patterns have found clinicians largely follow guidelines, with initial therapy consisting of pharmacological agents for rate [7][8][9] or rhythm control 10 . However, more recently, left atrial catheter ablation (LACA) is gaining in popularity, with the number of first-time procedures doubling in a 3 year span 11 despite the fact that LACA is invasive and associated with complications including stroke, transient ischemic attack, and, in rare cases, death [11][12][13] .…”