Cost of illness and drivers of cost in atrial fibrillation in Sweden and Germany.

BACKGROUND: Atrial fibrillation (AF) is an important public health problem in European countries. AF is associated with increased morbidity and mortality, e.g. from heart failure and thromboembolic events. Little data have previously been presented regarding the costs of treatment in patients with AF. OBJECTIVE: To estimate total direct and indirect costs in patients with AF in Sweden and Germany, and to identify determinants of total costs. METHODS: A cross-sectional observational study was conducted through surveys to patients and their treating physician in primary care and in hospital outpatient cardiology departments in Sweden and Germany. A total of 922 patients with AF as diagnosed in clinical practice were enrolled and completed the study. Data were collected on medical history, treatment, medical and non-medical resource use, and employment status. Costs (year 2005 values) were calculated by multiplying resources used with prices specific for Sweden and Germany, respectively. RESULTS: Total annual costs per patient were €7241 in Sweden and €5586 in Germany. Slightly less than 70% of total costs were judged as being AF related in both countries. Costs of AF-related medication were about 2% of total costs in both countries. In a generalized regression model, costs were found to increase with age, but were lower in patients aged>65 years than in those aged

Pharmacological rhythm and rate control treatment for atrial fibrillation: patient and physician satisfaction.

OBJECTIVE: : Atrial fibrillation (AF) represents a significant burden on healthcare resources. This study aimed to (i) identify key determinants for treatment choices in AF; (ii) analyze impacts of AF treatment on patient satisfaction and compliance; and (iii) analyze impacts of AF treatment on physician satisfaction and willingness to prescribe. METHODS: : Physicians and their patients with paroxysmal, persistent, and permanent AF were recruited and asked to respond to questionnaires. Patient and physician satisfaction was analyzed by specifying structural models with latent variables, using partial least squares (PLS) to estimate the models. RESULTS: : Physician satisfaction with available AF treatment was low (55 ± 1.3; p = 0.1, on a scale of 0-100), but physician willingness to prescribe in AF was high. AF patient satisfaction with current treatment was low (71 ± 1.2; p = 0.1), but despite this, their treatment compliance was rated as high (90 ± 0.9; p = 0.1). CONCLUSION: : The satisfaction with current AF treatment was low in patients with AF. Physician satisfaction with available AF drugs was driven by efficacy. The same appeared to be true for the patients - satisfaction, compliance, and functional ability would most likely increase with a perceived better drug efficacy.

Safe and effective conversion of persistent atrial fibrillation to sinus rhythm by intravenous AZD7009.

BACKGROUND: Acute drug conversion of persistent atrial fibrillation usually fails. OBJECTIVES: The purpose of this study was to test the proarrhythmic potential, safety, and efficacy of the novel antiarrhythmic agent AZD7009 in patients with persistent atrial fibrillation (AF) or atrial flutter (mean duration 43 days) scheduled for direct current (DC) cardioversion. METHODS: Patients were randomized to AZD7009 (3-hour intravenous infusion; n = 86) or placebo (n = 36). AZD7009 was given in doses intended to produce target pseudo-steady-state plasma levels of 0.25, 0.50, 0.75, 1.0, 1.5, 2.0, or 2.5 micromol/L after 30 minutes of infusion. DC cardioversion was performed if conversion to sinus rhythm (SR) did not occur within 2 hours of infusion. RESULTS: AZD7009 in a concentration-dependent manner increased the rate of conversion of AF to SR and shortened the time to conversion. At the three highest target concentrations of AZD7009, 45%, 64%, and 70% of AF patients converted after a mean time of 62, 55, and 26 minutes, respectively, whereas no placebo-treated patients converted. SR was maintained for 24 hours in 21 of 22 patients with drug-associated conversion. AZD7009 treatment was associated with QT-interval prolongation; the increase in QT corrected according to Fridericia typically ranged from 40 to 80 ms at targeted pseudo-steady-state plasma concentrations >or=0.75 micromol/L, but a number of outliers with QT corrected according to Fridericia >550 ms were seen in the higher concentration groups, particularly after conversion to SR and prolonged infusion. None of the patients exhibited torsades de pointes according to predefined criteria; however, one patient exhibited a nonsustained, polymorphic ventricular tachycardia of eight beats with torsades de pointes-like features after AZD7009 infusion (asymptomatic and discovered only upon retrospective Holter tape analysis). Clinical adverse events (primarily dizziness, bradycardia, hypotension, and nausea) were significantly more common in the highest target concentration AZD7009 group vs placebo (P <.001). CONCLUSION: AZD7009 exhibited dose-dependent effects in converting AF to SR in AF patients and appeared to be associated with a low risk of proarrhythmia despite continued administration during a period of heightened vulnerability.