Deborah A. Marshall, PhD; Adrian R. Levy, PhD; Humberto Vidaillet, MD; Elisabeth Fenwick, PhD; April Slee; Gordon Blackhouse, MSc; H. Leon Greene, MD; D. George Wyse, MD, PhD; Graham Nichol, MD; Bernie J. O'Brien, PhD†; and the AFFIRM and CORE Investigators*
Acknowledgments: The authors thank Mr. Tom Delea, Policy Analysis, Inc., for advice regarding costing. This paper is dedicated to our late mentor, colleague, coauthor, and friend, Bernie O'Brien.
Grant Support: AFFIRM was supported (contract N01-HC-55139) by the National Heart, Lung, and Blood Institute. The CORE study for the cost-effectiveness analysis is supported in part by the Canadian Institutes of Health Research Chronic Disease New Emerging Team Program, The Canadian Diabetes Association, The Kidney Foundation of Canada, the Heart and Stroke Foundation of Canada, and the Canadian Institutes of Health Research Institutes of Nutrition, Metabolism and Diabetes, Circulatory and Respiratory Health, and Gender and Health. Dr. Elisabeth Fenwick's postdoctoral fellowship was funded through a fellowship from Roche, Canada. Dr. Bernie J. O'Brien was supported by the Canadian Institutes of Health Research (CIHR). Dr. Graham Nichol is a Career Scientist of the Ontario Ministry of Health.
Potential Financial Conflicts of Interest: Consultancies: H. Vidaillet (Astra Zeneca); Honoraria: H. Vidaillet (Astra Zeneca); Grants received: G. Nichol (Medtronic Inc., Canadian Institutes of Health Research, Medtronic ERS, Cardiac Science, Zoll, Philips, National Heart, Lung, and Blood Institute); Grants pending: G. Nichol (Medtronic Inc., Medtronic ERS).
Requests for Single Reprints: Deborah Marshall, PhD, Center for Evaluation of Medicine, McMaster University, 25 Main Street West, Suite 2000, Hamilton, Ontario L6B 1H1, Canada; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Marshall: Department of Clinical Epidemiology and Biostatistics, McMaster University, Centre for Evaluation of Medicines, 25 Main Street West, Suite 2000, Hamilton, Ontario L6B 1H1, Canada.
Dr. Levy: Department of Health Care and Epidemiology, University of British Columbia, St. Paul's Hospital, 620B-1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada.
Dr. Vidaillet: Marshfield Clinic–Marshfield Center, 1000 North Oak Avenue, Marshfield, WI 54449.
Dr. Fenwick: Department of Economics and Related Studies and Centre for Health Economics, University of York, York Y0105DD, United Kingdom.
Ms. Slee and Dr. Greene: Axio Research Corporation, 2601 4th Avenue, Suite 200, Seattle, WA 98121.
Mr. Blackhouse: Program for Assessment of Technology in Health, McMaster University, 25 Main Street West, Suite 2000, Hamilton, Ontario L6B 1H1, Canada.
Dr. Wyse: Faculty of Medicine, University of Calgary, 3330 Hospital Drive Northwest, Calgary, Alberta T2N 4N1, Canada.
Dr. Nichol: University of Washington, Harborview Research and Training Center for Pre-Hospital Emergency Care, 325 Ninth Avenue, Seattle, WA 98104.
Author Contributions: Conception and design: D.A. Marshall, A.R. Levy, H. Vidaillet, E. Fenwick, D.G. Wyse, G. Nichol, B.J. O'Brien.
Analysis and interpretation of the data: D.A. Marshall, A.R. Levy, H. Vidaillet, E. Fenwick, A. Slee, G. Blackhouse, L. Greene, D.G. Wyse, G. Nichol, B.J. O'Brien.
Drafting of the article: D.A. Marshall, A.R. Levy, H. Vidaillet, D.G. Wyse, G. Nichol.
Critical revision of the article for important intellectual content: D.A. Marshall, A.R. Levy, H. Vidaillet, E. Fenwick, A. Slee, L. Greene, D.G. Wyse, G. Nichol, B.J. O'Brien.
Final approval of the article: D.A. Marshall, A.R. Levy, H. Vidaillet, E. Fenwick, D.G. Wyse, B.J. O'Brien.
Provision of study materials or patients: D.A. Marshall, H. Vidaillet, D.G. Wyse.
Statistical expertise: D.A. Marshall, A. Slee, G. Blackhouse.
Obtaining of funding: D.A. Marshall, A.R. Levy, L. Greene, D.G. Wyse.
Administrative, technical, or logistic support: D.A. Marshall.
Collection and assembly of data: D.A. Marshall, A.R. Levy, H. Vidaillet, L. Greene.
Marshall D., Levy A., Vidaillet H., Fenwick E., Slee A., Blackhouse G., Greene H., Wyse D., Nichol G., O'Brien B., ; Cost-Effectiveness of Rhythm versus Rate Control in Atrial Fibrillation. Ann Intern Med. 2004;141:653-661. doi: 10.7326/0003-4819-141-9-200411020-00005
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Published: Ann Intern Med. 2004;141(9):653-661.
Randomized trials show that rate control and rhythm control are similarly effective in the treatment of atrial fibrillation; therefore, economic issues will play a large role in the choice of therapy.
This cost-effectiveness model shows that rate control saves costs compared with rhythm control.
From an economic perspective, unless specific clinical factors suggest a benefit of rhythm control for a particular patient, rate control seems to be the preferred strategy for the management of atrial fibrillation.
Atrial fibrillation is the most common sustained type of cardiac arrhythmia treated by physicians. Its prevalence increases with advancing age, affecting approximately 5% of those 65 years of age and older and 10% of those older than 80 years of age (1-3). As the U.S. population ages, it is expected that more than 5 million persons will be living with atrial fibrillation by the year 2050 (4). Despite significant advances in the effectiveness of treatments for atrial fibrillation and its associated comorbid conditions, disability and mortality from atrial fibrillation remain high (5-10).
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