{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T16:43:36Z","timestamp":1761065016334,"version":"build-2065373602"},"reference-count":40,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2012,1,6]],"date-time":"2012-01-06T00:00:00Z","timestamp":1325808000000},"content-version":"vor","delay-in-days":219,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2011,6]]},"abstract":"<jats:p><jats:bold>Study Objective.<\/jats:bold> To compare lifetime costs and health outcomes of rate control versus rhythm control for management of atrial fibrillation in patients with coexisting heart failure from the third\u2010party payer perspective.<\/jats:p><jats:p><jats:bold>Design.<\/jats:bold> A Markov decision analysis model constructed from costs, utility, and transition probability inputs obtained from randomized clinical trials and publically available databases.<\/jats:p><jats:p><jats:bold>Patients.<\/jats:bold> A simulated cohort aged 65 years or older with persistent or paroxysmal atrial fibrillation and heart failure.<\/jats:p><jats:p><jats:bold>Measurements and Main Results.<\/jats:bold> Markov states for rhythm control were cardioversion plus amiodarone and maintenance amiodarone, and those for rate control were \u03b2\u2010blocker, digoxin, and calcium channel blocker. Transition states included treatment success, hospitalizations for atrial fibrillation and\/or heart failure, and severe adverse effects. Economic inputs included cost for drugs, cost of hospitalizations for atrial fibrillation and\/or heart failure, and cost of management of severe adverse effects. Costs were measured in 2009 U.S. dollars, and clinical outcomes in quality\u2010adjusted life\u2010years (QALYs). One\u2010way and multivariable sensitivity analyses were conducted. Uncertainty intervals (UIs) were obtained from probabilistic sensitivity analyses. Rate control was found to be less costly and more effective than rhythm control. Base case and probabilistic sensitivity analyses cost and effectiveness values for rate control were $7231 (95% UI $5517\u20139016) and 2.395 QALYs (95% UI 2.366\u20132.424 QALYs); whereas those for rhythm control were $16,291 (95% UI $11,033\u201321,434) and 2.197 QALYs (95% UI 2.155\u20132.237 QALYs). No critical values were found for any model parameters in the one\u2010way sensitivity analyses. The cost\u2010effectiveness acceptability curves showed that rate control was considered cost\u2010effective in 100% of cases at willingness\u2010to\u2010pay ratios between $0 and $200,000\/QALY.<\/jats:p><jats:p><jats:bold>Conclusion.<\/jats:bold> Rate control is less costly and more effective than rhythm control and should be the initial treatment for atrial fibrillation among patients with coexisting heart failure.<\/jats:p>","DOI":"10.1592\/phco.31.6.552","type":"journal-article","created":{"date-parts":[[2011,5,27]],"date-time":"2011-05-27T10:50:49Z","timestamp":1306493449000},"page":"552-565","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Comparison of Rate Control versus Rhythm Control for Management of Atrial Fibrillation in Patients with Coexisting Heart Failure: A Cost\u2010Effectiveness Analysis"],"prefix":"10.1002","volume":"31","author":[{"given":"Alexandra","family":"Perez","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel R.","family":"Touchette","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert J.","family":"DiDomenico","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas D.","family":"Stamos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Surrey M.","family":"Walton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2012,1,6]]},"reference":[{"key":"e_1_2_1_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.191259"},{"key":"e_1_2_1_3_2","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1016\/j.jacc.2006.07.009","article-title":"ACC\/AHA\/ESC 2006 guidelines for the management of patients with atrial fibrillation\u2014executive summary: a report of the American College of Cardiology\/American Heart Association task force on practice guidelines and the European Society of Cardiology committee for practice guidelines","volume":"48","author":"Fuster V.","year":"2006","journal-title":"J Am Coll Cardiol"},{"key":"e_1_2_1_4_2","doi-asserted-by":"publisher","DOI":"10.1185\/030079905X65475"},{"key":"e_1_2_1_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000072767.89944.6E"},{"key":"e_1_2_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.04.091"},{"key":"e_1_2_1_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa021328"},{"key":"e_1_2_1_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa021375"},{"key":"e_1_2_1_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(03)00332-2"},{"key":"e_1_2_1_10_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.126.2.476"},{"key":"e_1_2_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2005.10.057"},{"key":"e_1_2_1_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ehj.2004.06.020"},{"key":"e_1_2_1_13_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-141-9-200411020-00005"},{"key":"e_1_2_1_14_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-130-8-199904200-00002"},{"key":"e_1_2_1_15_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.158.15.1669"},{"key":"e_1_2_1_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2004.06.009"},{"key":"e_1_2_1_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2004.11.030"},{"key":"e_1_2_1_18_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0708789"},{"key":"e_1_2_1_19_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2008.158931"},{"key":"e_1_2_1_20_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1524-4733.2003.00234.x"},{"key":"e_1_2_1_21_2","first-page":"206","volume-title":"Pharmacoeconomics and outcomes: applications for patient care","author":"Touchette DR","year":"2003"},{"key":"e_1_2_1_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X9301300409"},{"key":"e_1_2_1_23_2","doi-asserted-by":"publisher","DOI":"10.2165\/00019053-199813040-00003"},{"key":"e_1_2_1_24_2","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X9401400107"},{"key":"e_1_2_1_25_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1996.03540160061034"},{"key":"e_1_2_1_26_2","unstructured":"Centers for Disease Control and Prevention.Abridged life table. 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