| Objective:For catheter ablation and drug in the treatment of atrial fibrillation in clinical research, through comparing the catheter ablation and anti-arrhythmic drugs two treatment strategies for the treatment of atrial fibrillation effectiveness, stability and safety, in order to make clear the characteristics of the two, to guide the treatment of atrial fibrillation.And then we try to develop scientific and reasonable treatment processes, provide the best treatment and an evaluation system for treatment of atrial fibrillation for patientsMethods:According to the inclusion criteria and exclusion criteria we included the 165 patients with atrial fibrillation in the period from December 2012 to September 2013 in Zhongshan hospital.81 cases of atrial fibrillation underwent radiofrequency ablation therapy (catheter ablation group) and 84 cases of atrial fibrillation patients received drug treatment group (drug group).Follow-up after ablation group and drug group in the treatment of recurrence of atrial fibrillation and sinus heart rate to maintain time, and whether after treatment had a stroke, bleeding, malignant arrhythmia and other end point events.Results:l.The clinical features of two groups, such as baseline comparable, in selected 165 patients with atrial fibrillation ablation group and drug group, in gender (71.6% vs 61.9%, male, P= 0.186), the average age (57.93+9.826 vs.61.17+12.394 years of age, P= 0.065), persistent atrial fibrillation (4.9% vs 10.7%, P= 0.169), hypertension (48.1% vs 41.7%, P= 0.403), coronary heart disease (2.5% vs 4.8%, P= 0.432), cardiac valvular disease (6.2% vs 6.0%, P= 0.953), and organic heart disease (9.9% vs 15.5%, P= 0.281), stroke or a past medical history of cerebral infarction (6.2% vs 14.3%, P= 0.087), and other aspects did not see obvious difference.Although the average size of left atrium diameter (41.06+5.241 vs.43.13 ±7.032 mm, P= 0.048) drug slightly bigger than the ablation group, but the proportion of patients with left atrial enlargement (55.1% vs 66.2%, P= 0.180), no difference. So in general, there is no significant differences in baseline levels of ablation group and drug group.2. After follow-up, ablation group average follow-up of 14.5+4.28 months, drug group average follow-up of 13.1±6.27 months, catheter ablation group has 32 patients of 81 cases in the treatment of 6 months in the recurrence of atrial fibrillation. In the drugtreatment group of 84 patients,56 patients relapsed within the six months; The recurrence rate of drug treatment group is higher than that of catheter ablation group (66.7% vs 39.5%, P< 0.001).Logistic regression analysis did not see other factors affect the recurrence rate.3. We make the K-M survival curve of sinus rhythm maintenance time of the two groups of patients with atrial fibrillation, it shows that after treatment until final inspection time, the sinus rhythm maintenance time of the ablation group is superior to the drug group. COX regression shows:ablation group is better than drug group on sinus rhythm maintaining rate (HR:3.46,95% CI:2.203～5.435, P< 0.001).4. Ablation group using warfarin for anticoagulation in patients more than the drug group (63/81 vs 40/84). After treatment,81 patients of the ablation group happened stroke in 4 patients and 8 cases in drug group of 84 patients (4.9% vs 9.5%, P= 0.257); Ablation group happened slight bleeding events in 3 patients, such as gum bleeding, spot of the skin and blood stasis, and in drug group happened bleeding events in 1 patients, (3.7% vs 1.2%, P= 0.294), both statistically.5. At the end of follow-up,81 cases of surgical ablation group patients did not appear pulmonary vein stenosis, esophagus atrial fistula, pericardial tamponade and other serious complications associated with surgery; All the 165 cases of catheter ablation and drug treatment group did not appear malignant arrhythmia or peripheral vascular embolization events;And 152 cases of patients with paroxysmal atrial fibrillation in did not appear to develop persistent atrial fibrillation.Conclusion:1. The recurrence rate of catheter ablation group is lower than the drug therapy group in 6 months.The conversion of rhythm in catheter ablation treatment is better than the drug treatment in the early stages.2. The rate of maintenance of sinus rhythm time in catheter ablation group is better than drug treatment group.Catheter ablation treatment maintain sinus rhythm better than drug therapy in the early stage.3. It shows no statistical differences of drug treatment and catheter ablation treatment in the event of a stroke, bleeding, the incidence of malignant arrhythmia and some end point events. There is no big difference in terms of security between drug treatment and catheter ablation treatmentObjective:Through observational research, comparative analysis of ablation group and drug group in the group and the group after 6 months in change of quality of life to make clear the improving of quality of life between catheter ablation therapy and drug therapy.Methods:According to the inclusion criteria and exclusion criteria we included the 165 patients with atrial fibrillation in the period from December 2012 to September 2013 in Zhongshan hospital.81 cases of atrial fibrillation underwent radiofrequency ablation therapy (catheter ablation group) and 84 cases of atrial fibrillation patients received drug treatment group (drug group). We follow-up the quality of life at the beginning of receiving treatment of ablation group and drug group and the quality of life of after treatment for 6 months. We try to compare and analysis the change of quality of life of the two groups according to the SF-36 quality rating scale.Results:1. The ablation group,81 cases of patients,6 months after treatment, in addition to the body pain on this dimension, there is just no statistical differences of SF-36 score before and after 6-months treatment. In seven other dimensions such as physiological function, physiological function, general health, vitality, social function, emotional role, mental health, including on the total physical health evaluation and total mental health evaluation, the SF-36 scale improved which the differences were statistically significant, P values were less than 0.05.2. In the ablation group, according to the presence of a recurrence within six months after surgery, the ablation group is divided into the successful surgery patients (49 cases) and unsuccessful surgery patients (32 cases). The SF-36 score is significantly improved in the group of successful surgery patients with visible ablation in the remaining seven dimensions and 2 general evaluation, besides the body pain dimension (P< 0.05).3. In the 84 patients of drug group, the SF-36 score increased statistically in the three dimensions of general health, vitality and mental health after the treatment for 6 months later (P< 0.05). No statistical difference on the rest of the dimensions.But the SF-36 score of the total evaluation in body health and mental healthon improved after the treatment and the difference was statistically significant (P< 0.05).4. For all those patients who accepted treatment after 6 months, we compare the SF-36 scale of quality of life for the drug group and the ablation group, we found that in addition to the physical function, role-physical and social function, the ablation group improved the score of quality of life more significantly than the drug group in the five dimensions of body pain, general health, vitality, emotional role and mental health (P< 0.05). Also the ablation group is higher than the drug group in the total physical evaluation and total mental health evaluation (P< 0.05).Conclusions:1. The catheter ablation therapy and drug therapy can both improve the quality of life in patients with atrial fibrillation, the improvement of the respective ways are different.2. The catheter ablation treatment can improve the quality of life for patients with atrial fibrillation more significantly than the drug treatment, especially for patients with successful ablation.3. Drug treatment maybe can not improve the quality of lfie obviously for patients with atrial fibrillation, but in many ways it has a tendency to rise.Objective:By means of health economics, we compare the economics characteristics in patients with atrial fibrillation of ablation therapy group and drug therapy group and evaluate the reasonable strategies of economic treatment of atrial fibrillation to make the maximum benefits for the patients with atrial fibrillation..Methods:According to the inclusion criteria and exclusion criteria we included the 165 patients with atrial fibrillation in the period from December 2012 to September 2013 in Zhongshan hospital.81 cases of atrial fibrillation underwent radiofrequency ablation therapy (catheter ablation group) and 84 cases of atrial fibrillation patients received drug treatment group (drug group). We follow-up the economic cost within six months after treatment of the ablation group and the drug group. We do cost effect analysis, cost-effectiveness analysis, prevention benefit analysis and sensitivity analysis. We try to form a evaluation module for the cost in the period time of follow up to forecast the long-term economic benefits.Results:1. Through follow-up, understand the cost of ablation group and drug group patients in the period of 6 months after treatment:the direct cost of the patients in ablation group within the 6 months is 51198.46 yuan per capita in average and the drug group is 7825.88 yuan per capita in average within the 6 months.2. We do cost-effectiveness analysis for the patients of the two groups. The cost of the ablation group effect than C1/El is 658.07, the cost of the drug group effect than C2/E2 is 139.74.Than as a reference to the cost of the drug group effect, ablation group and the incremental cost-effectiveness than delta C/delta E, namely (C1 and C2)/(E1 and E2)= 1989.56.Its significance for, for the treatment of patients with atrial fibrillation, an average raise a unit of efficient, cost 1989.56 yuan.3. We do cost utility analysis for the patients of the two groups.The CUR1 of ablation group was 933.42;The CUR2 of the drug group is 272.77;The ratio of incremental cost and utility is 1660.51.4.6 months after treatment, in the 81 patients of the ablation group,3 patients hospitalized for the additional events, average hospitalization expense is 17204.3 yuan.And the drug group happened 11, the average hospitalization expense is 16045.45 yuan.On prevention benefit, drug group spent 176499.95 yuan more for extra hospital for patients with drug group 84 cases, more waste per capita 2101.2 yuan.And ablation group spent 51612.9 yuan more for extra hospital, more waste per capita 637.2 yuan. The ablation group save 1464 yuan than the drug group per capita.5. We form the linear regression model for the two groups, the dependent variable Y is defined as the total cost during the period form the beginning until the deadline; The covariate Xi is defined as the time after included into the group; The covariate X2 is defined as the times for outpatient services; The covariate X3 is defined as the additional hospitalization. We concluded that the regression equation of the ablation group:Y= 68377.18+1324.16 X2+68377.18 X3, and the regression equation of the drug group:Y= 743.38 Xi+16138.82X3-939.5.By estimate, about 7.7 years or so, the cost of drug expenses and ablation group was flat, but after that, the cost of the drug group will exceed the ablation group, and the rising cost of rate is higher than ablation group.Conclusions:1. Although the ablation group on the treatment efficiency and life quality is better than that of drug group, but the price is too expensive, drug treatment more economic, feasible more good;2. The catheter ablation therapy can effectively reduce the extra hospital outcome events in patients with atrial fibrillation, save a certain amount of cost on prevention benefit.3. In the future, the rate of cost for drug treatment will exceed the ablation group, catheter ablation treatment began to reflect the advantages and benefits of economics. |
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