QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Extracto Full Text PDF Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Choudhry, N. K Articles by Mamdani, M. Search for Related Content PubMed PubMed Citation Articles by Choudhry, N. K Articles by Mamdani, M.

CARDIOLOGY

Comparison of the Impact of the Atrial Fibrillation Follow-Up Investigation of Rhythm Management Trial on Prescribing Patterns: A Time-Series Analysis

Assistant Professor, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA

Brandon Zagorski, MS

Analyst, The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

Jerry Avorn, MD

Professor and Chief, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School

Raisa Levin, MS

Senior Programmer, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School

Kathy Sykora, MSc

Director, Programming and Biostatistics, The Institute for Clinical Evaluative Sciences

Andreas Laupacis, MD MSc

Professor, Faculty of Medicine, University of Toronto; Executive Director, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario

Muhammad Mamdani, PharmD MA MPH

Associate Professor, Faculty of Medicine, Health Policy, Management and Evaluation and Pharmacy, University of Toronto; Director, Applied Health Research Centre, St. Michael's Hospital, Toronto

Reprints: Dr. Choudhry, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont St., Suite 3030, Boston, MA 02120, fax 617/232-8602, nchoudhry{at}partners.org

BACKGROUND: The AFFIRM (Atrial Fibrillation Follow-Up Investigation of Rhythm Management) trial demonstrated that rate control and rhythm control strategies result in similar survival and quality of life for patients with atrial fibrillation (AF). Because of superior safety and lower cost, rate control is now the recommended strategy for the management of most elderly, high-risk AF patients.

OBJECTIVE: To determine the extent to which the AFFIRM trial results have been adopted into actual practice.

METHODS: We conducted a time-series analysis of 3 population-based cohorts of patients with AF who were 66 years of age or older in Pennsylvania and Ontario. We stratified patients in Ontario by socioeconomic status (SES) and examined changes in quarterly prescription rates for rate control and rhythm controlling medications as well as cardioversion procedures before and after publication of the AFFIRM trial.

RESULTS: The publication of the AFFIRM trial resulted in statistically significant reductions in the use of rhythm controlling medications in all 3 cohorts (p < 0.01). The magnitude of these changes in the non-low SES Canadian cohort was approximately 1% per quarter and was greater than the magnitude observed in the other cohorts (p < 0.001). The use of cardioversion procedures also decreased in all study regions (p < 0.01). In contrast, AFFIRM publication was also associated with a small increase in the use of rate controlling medications in Canada (p < 0.01) but not in the US (p = 0.23).

CONCLUSIONS: Publication of the AFFIRM trial resulted in small but statistically significant changes in the care of patients with AF.

Key Words: atrial fibrillation, practice patterns, prescribing

Published Online, September 30, 2008. www.theannals.com, DOI 10.1345/aph.1L211