scholarly journals Cost-Effectiveness and Clinical Effectiveness of the Risk Factor Management Clinic in Atrial Fibrillation

2017 ◽  
Vol 3 (5) ◽  
pp. 436-447 ◽  
Author(s):  
Rajeev K. Pathak ◽  
Michelle Evans ◽  
Melissa E. Middeldorp ◽  
Rajiv Mahajan ◽  
Abhinav B. Mehta ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Cost Effectiveness ◽  
Clinical Effectiveness ◽  
Risk Factor Management

scholarly journals Quality indicators for the care and outcomes of adults with atrial fibrillation

EP Europace ◽  
2020 ◽  
Author(s):  
Elena Arbelo ◽  
Suleman Aktaa ◽  
Andreas Bollmann ◽  
André D’Avila ◽  
Inga Drossart ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Quality Indicators ◽  
Control Strategy ◽  
Rate Control ◽  
Rhythm Control ◽  
Patient Assessment ◽  
Risk Factor Management ◽  
Diagnosis And Management

Abstract Aims To develop quality indicators (QIs) that may be used to evaluate the quality of care and outcomes for adults with atrial fibrillation (AF). Methods and results We followed the ESC methodology for QI development. This methodology involved (i) the identification of the domains of AF care for the diagnosis and management of AF (by a group of experts including members of the ESC Clinical Practice Guidelines Task Force for AF); (ii) the construction of candidate QIs (including a systematic review of the literature); and (iii) the selection of the final set of QIs (using a modified Delphi method). Six domains of care for the diagnosis and management of AF were identified: (i) Patient assessment (baseline and follow-up), (ii) Anticoagulation therapy, (iii) Rate control strategy, (iv) Rhythm control strategy, (v) Risk factor management, and (vi) Outcomes measures, including patient-reported outcome measures (PROMs). In total, 17 main and 17 secondary QIs, which covered all six domains of care for the diagnosis and management of AF, were selected. The outcome domain included measures on the consequences and treatment of AF, as well as PROMs. Conclusion This document defines six domains of AF care (patient assessment, anticoagulation, rate control, rhythm control, risk factor management, and outcomes), and provides 17 main and 17 secondary QIs for the diagnosis and management of AF. It is anticipated that implementation of these QIs will improve the quality of AF care.

scholarly journals Dronedarone for the treatment of atrial fibrillation and atrial flutter

2010 ◽  
Vol 14 (Suppl 2) ◽  
pp. 55-62
Author(s):  
E Maund ◽  
C McKenna ◽  
M Sarowar ◽  
D Fox ◽  
M Stevenson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
Adverse Events ◽  
Clinical Effectiveness ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Serious Adverse Events ◽  
Ventricular Ejection Fraction ◽  
All Cause Mortality ◽  
Af Recurrence

This paper presents a summary of the evidence review group (ERG) report on the clinical effectiveness and cost-effectiveness of dronedarone for the treatment of atrial fibrillation (AF) or atrial flutter based upon a review of the manufacturer’s submission to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal process. The population considered in the submission were adult clinically stable patients with a recent history of or current non-permanent AF. Comparators were the current available anti-arrhythmic drugs: class 1c agents (flecainide and propafenone), sotalol and amiodarone. Outcomes were AF recurrence, all-cause mortality, stroke, treatment discontinuations (due to any cause or due to adverse events) and serious adverse events. The main evidence came from four phase III randomised controlled trials, direct and indirect meta-analyses from a systematic review, and a synthesis of the direct and indirect evidence using a mixed-treatment comparison. Overall, the results from the different synthesis approaches showed that the odds of AF recurrence appeared statistically significantly lower with dronedarone and other anti-arrhythmic drugs than with non-active control, and that the odds of AF recurrence are statistically significantly higher for dronedarone than for amiodarone. However, the results for outcomes of all-cause mortality, stroke and treatment discontinuations and serious adverse events were all uncertain. A discrete event simulation model was used to evaluate dronedarone versus antiarrhythmic drugs and standard therapy alone. The incremental cost-effectiveness ratio of dronedarone was relatively robust and less than £20,000 per quality-adjusted life-year. Exploratory work undertaken by the ERG identified that the main drivers of cost-effectiveness were the benefits assigned to dronedarone for all-cause mortality and stroke. Dronedarone is not cost-effective relative to its comparators when the only effect of treatment is a reduction in AF recurrences. In conclusion, uncertainties remain in the clinical effectiveness and cost-effectiveness of dronedarone. In particular, the clinical evidence for the major drivers of cost-effectiveness (all-cause mortality and stroke), and consequently the additional benefits attributed in the economic model to dronedarone compared to other anti-arrhythmic drugs are highly uncertain. The final guidance, issued by NICE on 25 August 2010, states that: Dronedarone is recommended as an option for the treatment of non-permanent atrial fibrillation only in people: whose atrial fibrillation is not controlled by first-line therapy (usually including beta-blockers), that is, as a second-line treatment option, and who have at least one of the following cardiovascular risk factors: - hypertension requiring drugs of at least two different classes, diabetes mellitus, previous transient ischaemic attack, stroke or systemic embolism, left atrial diameter of 50 mm or greater, left ventricular ejection fraction less than 40% (noting that the summary of product characteristics [SPC] does not recommend dronedarone for people with left ventricular ejection fraction less than 35% because of limited experience of using it in this group) or age 70 years or older, and who do not have unstable New York Heart Association (NYHA) class III or IV heart failure. Furthermore, ‘People who do not meet the criteria above who are currently receiving dronedarone should have the option to continue treatment until they and their clinicians consider it appropriate to stop’.

Risk Factor Management and Atrial Fibrillation Clinics: Saving the Best for Last?

2017 ◽  
Vol 26 (9) ◽  
pp. 990-997 ◽  
Author(s):  
Rajiv Mahajan ◽  
Rajeev K. Pathak ◽  
Anand Thiyagarajah ◽  
Dennis H. Lau ◽  
Francis E. Marchlinski ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Risk Factor Management

scholarly journals On‐demand mobile health infrastructures to allow comprehensive remote atrial fibrillation and risk factor management through teleconsultation

2020 ◽  
Vol 43 (11) ◽  
pp. 1232-1239 ◽  
Author(s):  
Astrid N. L. Hermans ◽  
Rachel M. J. Velden ◽  
Monika Gawalko ◽  
Dominique V. M. Verhaert ◽  
Lien Desteghe ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Mobile Health ◽  
Risk Factor Management ◽  
On Demand

scholarly journals Efficacy and cost-effectiveness of a therapist-assisted web-based intervention for depression and anxiety in patients with ischemic heart disease attending cardiac rehabilitation [eMindYourHeart trial]: a randomised controlled trial protocol

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Susanne S. Pedersen ◽  
Christina M. Andersen ◽  
Robert Ahm ◽  
Søren J. Skovbakke ◽  
Robin Kok ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cost Effectiveness ◽  
Controlled Trial ◽  
Depression And Anxiety ◽  
Comorbid Depression ◽  
Risk Factor Management ◽  
Symptoms Of Depression ◽  
Ehealth Intervention ◽  
Randomised Controlled

Abstract Background One in five patients with ischaemic heart disease (IHD) develop comorbid depression or anxiety. Depression is associated with risk of non-adherence to cardiac rehabilitation (CR) and dropout, inadequate risk factor management, poor quality of life (QoL), increased healthcare costs and premature death. In 2020, IHD and depression are expected to be among the top contributors to the disease-burden worldwide. Hence, it is paramount to treat both the underlying somatic disease as well as depression and anxiety. eMindYourHeart will evaluate the efficacy and cost-effectiveness of a therapist-assisted eHealth intervention targeting depression and anxiety in patients with IHD, which may help fill this gap in clinical care. Methods eMindYourHeart is a multi-center, two-armed, unblinded randomised controlled trial that will compare a therapist-assisted eHealth intervention to treatment as usual in 188 CR patients with IHD and comorbid depression or anxiety. The primary outcome of the trial is symptoms of depression, measured with the Hospital Anxiety and Depression Scale (HADS) at 3 months. Secondary outcomes evaluated at 3, 6, and 12 months include symptoms of depression and anxiety (HADS), perceived stress, health complaints, QoL (HeartQoL), trial dropout (number of patients dropped out in either arm at 3 months) and cost-effectiveness. Discussion To our knowledge, this is the first trial to evaluate both the efficacy and cost-effectiveness of a therapist-assisted eHealth intervention in patients with IHD and comorbid psychological distress as part of CR. Integrating screening for and treatment of depression and anxiety into standard CR may decrease dropout and facilitate better risk factor management, as it is presented as “one package” to patients, and they can access the eMindYourHeart program in their own time and at their own convenience. The trial holds a strong potential for improving the quality of care for an increasing population of patients with IHD and comorbid depression, anxiety or both, with likely benefits to patients, families, and society at large due to potential reductions in direct and indirect costs, if proven successful. Trial registration The trial was prospectively registered on https://clinicaltrials.gov/ct2/show/NCT04172974 on November 21, 2019 with registration number [NCT04172974].

Risk Factor Management Before and After Atrial Fibrillation Ablation

2020 ◽  
Vol 12 (2) ◽  
pp. 141-154 ◽  
Author(s):  
Jonathan P. Ariyaratnam ◽  
Melissa Middeldorp ◽  
Gijo Thomas ◽  
Jean Jacques Noubiap ◽  
Dennis Lau ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Atrial Fibrillation Ablation ◽  
Risk Factor Management ◽  
Before And After

scholarly journals Gender differences and daily variation in atrial fibrillation risk factor profiles: Considerations for risk factor management

2019 ◽  
Vol 25 ◽  
pp. 100442
Author(s):  
Nikki A.H.A. Pluymaekers ◽  
Astrid N.L. Hermans ◽  
Melissa E. Middeldorp ◽  
Kadhim Kadhim ◽  
Harry J.G.M. Crijns ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Gender Differences ◽  
Risk Factor ◽  
Daily Variation ◽  
Risk Factor Management

P1211Does socioeconomic factors influence the outcomes of risk factor management and freedom of patients with atrial fibrillation

EP Europace ◽  
2018 ◽  
Vol 20 (suppl_1) ◽  
pp. i236-i237
Author(s):  
M E Middeldorp ◽  
A D Elliott ◽  
R K Pathak ◽  
A Gupta ◽  
C Gallagher ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Socioeconomic Factors ◽  
Risk Factor Management
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