Atrial Fibrillation Management Options

Mission

ICER's mission is to lead innovation in comparative effectiveness research through methods that integrate considerations of clinical benefit and economic value. Through a unique collaboration with patients, clinicians, manufacturers, insurers and other healthcare stakeholders, ICER develops tools to support patient decisions and medical policy that share the goal of achieving maximum value for every healthcare dollar.

Atrial fibrillation (AF) is the most common cardiac arrhythmia seen in clinical practice, affecting approximately 2.5 million persons in the U.S. AF is not only common but also carries significant risks of mortality and morbidity, raising the risk of stroke more than five-fold and contributing to an estimated 15-20% of strokes annually in the U.S. Even patients with AF who do not suffer a stroke often experience diminished quality of life and require frequent hospitalization.

This appraisal will evaluate the evidence on the comparative risks, benefits, and cost-effectiveness of management strategies for patients with AF. We will include in the scope of the appraisal:

Antiarrhythmic drug therapy to return the heart to sinus rhythm
Radiofrequency catheter ablation to terminate AF and prevent further episodes
Minimally-invasive surgical techniques to terminate AF and prevent further episodes
Aspirin, warfarin, and dabigatran for anticoagulation to prevent strokes
The WATCHMAN left atrial appendage occlusive device to prevent strokes