Quality of Life and Health Care Utilization in the CIRCA-DOSE Study

CIRCA-DOSE Study Investigators

doi:10.1016/j.jacep.2020.04.017

Quality of Life and Health Care Utilization in the CIRCA-DOSE Study

CIRCA-DOSE Study Investigators

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32 Citas (Scopus)

Resumen

Objectives: This study evaluated the impact of contact force–guided radiofrequency ablation versus cryoballoon ablation on quality of life and health care utilization. Background: Traditional outcome parameters, such as arrhythmia-free survival, are insufficient to evaluate the clinical impact of atrial fibrillation (AF), as it fails to the capture patient- and health system–level differences in treatment approaches. Methods: The CIRCA-DOSE (Cryoballoon Vs. Contact-Force Atrial Fibrillation Ablation) study randomly assigned 346 patients with drug-refractory paroxysmal AF to contact force–guided radiofrequency or cryoballoon ablation. Health-related quality-of-life (HRQOL) was assessed at baseline, and at 6 and 12 months post-ablation using a disease-specific and generic HRQOL instruments. Health care utilization (hospitalization, emergency department visits, and cardioversion) and antiarrhythmic drug use for the 12 months preceding ablation was compared with the 12 months following ablation. Results: Disease-specific and generic HRQOL was moderately to severely impaired at baseline and improved significantly at 6 and 12 months of follow-up (median improvement in AFEQT [Atrial Fibrillation Effect on QualiTy of Life] score 32.4 [interquartile range: 17.7 to 48.9]). When compared with the 12 months pre-ablation, the proportion and absolute number of cardioversions decreased significantly (41.1% vs. 10.1% of patients, 137 vs. 35 events; p < 0.0001). Similar significant reductions in emergency department visits (66.7% vs. 25.1% of patients, 224 vs. 87 events; p < 0.0001), and hospitalizations (25.5% vs. 14.5% of patients, 86 vs. 50 events; p < 0.001) were observed. There were no significant differences between randomized groups. Conclusions: In this multicenter randomized trial, catheter ablation with advanced-generation technologies resulted in a significant improvement in HRQOL and a significant reduction in health care utilization in the year following AF ablation. (Cryoballoon vs. Irrigated Radiofrequency Catheter Ablation [CIRCA-DOSE]; NCT01913522)

Idioma original	English
Páginas (desde-hasta)	935-944
Número de páginas	10
Publicación	JACC: Clinical Electrophysiology
Volumen	6
N.º	8
DOI	https://doi.org/10.1016/j.jacep.2020.04.017
Estado	Published - ago. 2020
Publicado de forma externa	Sí

Nota bibliográfica

Funding Information:
The CIRCA-DOSE study was funded by a peer-reviewed grant from the Heart and Stroke Foundation of Canada (grant number G-13-0003121), with additional financial support from Medtronic, and the Heart Rhythm Services at the University of British Columbia. Drs. Andrade and Deyell are supported by a Michael Smith Foundation for Health Research Scholar Award. Dr. Khairy is supported by a research chair in electrophysiology and congenital heart disease. Dr. Andrade has received grant support from Medtronic and Baylis; and has received personal fees from Medtronic and Biosense Webster. Dr. Macle has received personal fees from Medtronic, St. Jude Medical/Abbott, and Biosense Webster; and has received grant support from St. Jude Medical/Abbott and Biosense Webster. Dr. Verma has received grant support from Medtronic, Biosense Webster, and Bayer; has received personal fees from Medtronic and Biosense Webster; and served on the advisory board for Medtronic and Boston Scientific. Dr. Deyell has received grant support from Biosense Webster; and has received honoraria from Biosense Webster and Medtronic. Dr. Dubuc has received grants and personal fees from Medtronic. Dr. Leong-Sit has received personal fees from Medtronic, Baylis, and Biosense Webster. Dr. Roux has served on the Speakers Bureau and advisory board for Biosense Webster. Dr. Sapp has received grant support from Biosense Webster and St. Jude Medical/Abbott; and has received speaker honoraria from Medtronic and Biosense Webster. Dr. Tang has received grant support from Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Isabel Deisenhofer, MD, served as Guest Editor for this paper.

Publisher Copyright:
© 2020 American College of Cardiology Foundation

ASJC Scopus Subject Areas

Cardiology and Cardiovascular Medicine
Physiology (medical)

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@article{abb56289173c435089dcdd0173159458,

title = "Quality of Life and Health Care Utilization in the CIRCA-DOSE Study",

abstract = "Objectives: This study evaluated the impact of contact force–guided radiofrequency ablation versus cryoballoon ablation on quality of life and health care utilization. Background: Traditional outcome parameters, such as arrhythmia-free survival, are insufficient to evaluate the clinical impact of atrial fibrillation (AF), as it fails to the capture patient- and health system–level differences in treatment approaches. Methods: The CIRCA-DOSE (Cryoballoon Vs. Contact-Force Atrial Fibrillation Ablation) study randomly assigned 346 patients with drug-refractory paroxysmal AF to contact force–guided radiofrequency or cryoballoon ablation. Health-related quality-of-life (HRQOL) was assessed at baseline, and at 6 and 12 months post-ablation using a disease-specific and generic HRQOL instruments. Health care utilization (hospitalization, emergency department visits, and cardioversion) and antiarrhythmic drug use for the 12 months preceding ablation was compared with the 12 months following ablation. Results: Disease-specific and generic HRQOL was moderately to severely impaired at baseline and improved significantly at 6 and 12 months of follow-up (median improvement in AFEQT [Atrial Fibrillation Effect on QualiTy of Life] score 32.4 [interquartile range: 17.7 to 48.9]). When compared with the 12 months pre-ablation, the proportion and absolute number of cardioversions decreased significantly (41.1% vs. 10.1% of patients, 137 vs. 35 events; p < 0.0001). Similar significant reductions in emergency department visits (66.7% vs. 25.1% of patients, 224 vs. 87 events; p < 0.0001), and hospitalizations (25.5% vs. 14.5% of patients, 86 vs. 50 events; p < 0.001) were observed. There were no significant differences between randomized groups. Conclusions: In this multicenter randomized trial, catheter ablation with advanced-generation technologies resulted in a significant improvement in HRQOL and a significant reduction in health care utilization in the year following AF ablation. (Cryoballoon vs. Irrigated Radiofrequency Catheter Ablation [CIRCA-DOSE]; NCT01913522)",

author = "{CIRCA-DOSE Study Investigators} and Andrade, {Jason G.} and Laurent Macle and Atul Verma and Deyell, {Marc W.} and Jean Champagne and Marc Dubuc and Peter Leong-Sit and Paul Novak and Roux, {Jean Francois} and John Sapp and Clarence Khoo and Jacques Rizkallah and Sylvie Levesque and Tang, {Anthony S.L.} and Paul Khairy",

note = "Funding Information: The CIRCA-DOSE study was funded by a peer-reviewed grant from the Heart and Stroke Foundation of Canada (grant number G-13-0003121), with additional financial support from Medtronic, and the Heart Rhythm Services at the University of British Columbia. Drs. Andrade and Deyell are supported by a Michael Smith Foundation for Health Research Scholar Award. Dr. Khairy is supported by a research chair in electrophysiology and congenital heart disease. Dr. Andrade has received grant support from Medtronic and Baylis; and has received personal fees from Medtronic and Biosense Webster. Dr. Macle has received personal fees from Medtronic, St. Jude Medical/Abbott, and Biosense Webster; and has received grant support from St. Jude Medical/Abbott and Biosense Webster. Dr. Verma has received grant support from Medtronic, Biosense Webster, and Bayer; has received personal fees from Medtronic and Biosense Webster; and served on the advisory board for Medtronic and Boston Scientific. Dr. Deyell has received grant support from Biosense Webster; and has received honoraria from Biosense Webster and Medtronic. Dr. Dubuc has received grants and personal fees from Medtronic. Dr. Leong-Sit has received personal fees from Medtronic, Baylis, and Biosense Webster. Dr. Roux has served on the Speakers Bureau and advisory board for Biosense Webster. Dr. Sapp has received grant support from Biosense Webster and St. Jude Medical/Abbott; and has received speaker honoraria from Medtronic and Biosense Webster. Dr. Tang has received grant support from Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Isabel Deisenhofer, MD, served as Guest Editor for this paper. Publisher Copyright: {\textcopyright} 2020 American College of Cardiology Foundation",

year = "2020",

month = aug,

doi = "10.1016/j.jacep.2020.04.017",

language = "English",

volume = "6",

pages = "935--944",

journal = "JACC: Clinical Electrophysiology",

issn = "2405-500X",

publisher = "Elsevier USA",

number = "8",

}

TY - JOUR

T1 - Quality of Life and Health Care Utilization in the CIRCA-DOSE Study

AU - CIRCA-DOSE Study Investigators

AU - Andrade, Jason G.

AU - Macle, Laurent

AU - Verma, Atul

AU - Deyell, Marc W.

AU - Champagne, Jean

AU - Dubuc, Marc

AU - Leong-Sit, Peter

AU - Novak, Paul

AU - Roux, Jean Francois

AU - Sapp, John

AU - Khoo, Clarence

AU - Rizkallah, Jacques

AU - Levesque, Sylvie

AU - Tang, Anthony S.L.

AU - Khairy, Paul

N1 - Funding Information: The CIRCA-DOSE study was funded by a peer-reviewed grant from the Heart and Stroke Foundation of Canada (grant number G-13-0003121), with additional financial support from Medtronic, and the Heart Rhythm Services at the University of British Columbia. Drs. Andrade and Deyell are supported by a Michael Smith Foundation for Health Research Scholar Award. Dr. Khairy is supported by a research chair in electrophysiology and congenital heart disease. Dr. Andrade has received grant support from Medtronic and Baylis; and has received personal fees from Medtronic and Biosense Webster. Dr. Macle has received personal fees from Medtronic, St. Jude Medical/Abbott, and Biosense Webster; and has received grant support from St. Jude Medical/Abbott and Biosense Webster. Dr. Verma has received grant support from Medtronic, Biosense Webster, and Bayer; has received personal fees from Medtronic and Biosense Webster; and served on the advisory board for Medtronic and Boston Scientific. Dr. Deyell has received grant support from Biosense Webster; and has received honoraria from Biosense Webster and Medtronic. Dr. Dubuc has received grants and personal fees from Medtronic. Dr. Leong-Sit has received personal fees from Medtronic, Baylis, and Biosense Webster. Dr. Roux has served on the Speakers Bureau and advisory board for Biosense Webster. Dr. Sapp has received grant support from Biosense Webster and St. Jude Medical/Abbott; and has received speaker honoraria from Medtronic and Biosense Webster. Dr. Tang has received grant support from Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Isabel Deisenhofer, MD, served as Guest Editor for this paper. Publisher Copyright: © 2020 American College of Cardiology Foundation

PY - 2020/8

Y1 - 2020/8

N2 - Objectives: This study evaluated the impact of contact force–guided radiofrequency ablation versus cryoballoon ablation on quality of life and health care utilization. Background: Traditional outcome parameters, such as arrhythmia-free survival, are insufficient to evaluate the clinical impact of atrial fibrillation (AF), as it fails to the capture patient- and health system–level differences in treatment approaches. Methods: The CIRCA-DOSE (Cryoballoon Vs. Contact-Force Atrial Fibrillation Ablation) study randomly assigned 346 patients with drug-refractory paroxysmal AF to contact force–guided radiofrequency or cryoballoon ablation. Health-related quality-of-life (HRQOL) was assessed at baseline, and at 6 and 12 months post-ablation using a disease-specific and generic HRQOL instruments. Health care utilization (hospitalization, emergency department visits, and cardioversion) and antiarrhythmic drug use for the 12 months preceding ablation was compared with the 12 months following ablation. Results: Disease-specific and generic HRQOL was moderately to severely impaired at baseline and improved significantly at 6 and 12 months of follow-up (median improvement in AFEQT [Atrial Fibrillation Effect on QualiTy of Life] score 32.4 [interquartile range: 17.7 to 48.9]). When compared with the 12 months pre-ablation, the proportion and absolute number of cardioversions decreased significantly (41.1% vs. 10.1% of patients, 137 vs. 35 events; p < 0.0001). Similar significant reductions in emergency department visits (66.7% vs. 25.1% of patients, 224 vs. 87 events; p < 0.0001), and hospitalizations (25.5% vs. 14.5% of patients, 86 vs. 50 events; p < 0.001) were observed. There were no significant differences between randomized groups. Conclusions: In this multicenter randomized trial, catheter ablation with advanced-generation technologies resulted in a significant improvement in HRQOL and a significant reduction in health care utilization in the year following AF ablation. (Cryoballoon vs. Irrigated Radiofrequency Catheter Ablation [CIRCA-DOSE]; NCT01913522)

AB - Objectives: This study evaluated the impact of contact force–guided radiofrequency ablation versus cryoballoon ablation on quality of life and health care utilization. Background: Traditional outcome parameters, such as arrhythmia-free survival, are insufficient to evaluate the clinical impact of atrial fibrillation (AF), as it fails to the capture patient- and health system–level differences in treatment approaches. Methods: The CIRCA-DOSE (Cryoballoon Vs. Contact-Force Atrial Fibrillation Ablation) study randomly assigned 346 patients with drug-refractory paroxysmal AF to contact force–guided radiofrequency or cryoballoon ablation. Health-related quality-of-life (HRQOL) was assessed at baseline, and at 6 and 12 months post-ablation using a disease-specific and generic HRQOL instruments. Health care utilization (hospitalization, emergency department visits, and cardioversion) and antiarrhythmic drug use for the 12 months preceding ablation was compared with the 12 months following ablation. Results: Disease-specific and generic HRQOL was moderately to severely impaired at baseline and improved significantly at 6 and 12 months of follow-up (median improvement in AFEQT [Atrial Fibrillation Effect on QualiTy of Life] score 32.4 [interquartile range: 17.7 to 48.9]). When compared with the 12 months pre-ablation, the proportion and absolute number of cardioversions decreased significantly (41.1% vs. 10.1% of patients, 137 vs. 35 events; p < 0.0001). Similar significant reductions in emergency department visits (66.7% vs. 25.1% of patients, 224 vs. 87 events; p < 0.0001), and hospitalizations (25.5% vs. 14.5% of patients, 86 vs. 50 events; p < 0.001) were observed. There were no significant differences between randomized groups. Conclusions: In this multicenter randomized trial, catheter ablation with advanced-generation technologies resulted in a significant improvement in HRQOL and a significant reduction in health care utilization in the year following AF ablation. (Cryoballoon vs. Irrigated Radiofrequency Catheter Ablation [CIRCA-DOSE]; NCT01913522)

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Quality of Life and Health Care Utilization in the CIRCA-DOSE Study

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