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Economic analysis of a transesophageal echocardiography-guided approach to cardioversion of patients with atrial fibrillation

The ACUTE economic data at eight weeks

Allan L. Klein, MD, FACC^*,*, R. Daniel Murray, PhD^*, Edmund R. Becker, PhD, Steven D. Culler, PhD, William S. Weintraub, MD, FACC, Susan E. Jasper, RN, BSN^*, Elizabeth A. Lieber, BA, Carolyn Apperson-Hansen, MStat, Adrienne M. Heerey, PhD^*, Richard A. Grimm, DO, FACC^* ACUTE Investigators

^* Department of Cardiovascular Medicine, the Cleveland Clinic Foundation, Cleveland, Ohio, USA
Department of Biostatistics and Epidemiology, the Cleveland Clinic Foundation, Cleveland, Ohio, USA
Department of Cardiology, School of Medicine and the Rollins School of Public Health, Emory University, Atlanta, Georgia, USA

View larger version (23K): [in a new window]   Figure 1 A diagram illustrating the Assessment of Cardioversion Using Transesophageal Echocardiography trial (ACUTE) protocol. Patients were randomly assigned to either a transesophageal echocardiography (TEE)-guided or conventional group; TEE-guided patients, without thrombus by TEE, received early cardioversion with short-term therapeutic anticoagulation. Transesophageal echocardiography-guided patients with thrombus received three weeks anticoagulation and repeat TEE. Conventional patients received no TEE and three weeks anticoagulation before cardioversion. All patients received four weeks of therapeutic anticoagulation after cardioversion. DCC = direct current cardioversion.

View larger version (24K): [in a new window]   Figure 2 Sensitivity of the effect of varying the incidence and the cost of a major bleeding event (A) on the difference in the treatment costs between a transesophageal echocardiography (TEE)-guided and conventionally treated patient for the analytic model; effect of varying the cost of TEE on the difference in treatment costs (B) (including adverse events) between a TEE-guided and conventionally treated patient for the analytic model. The y axis shows the difference in cost of treating a TEE-guided patient minus a conventionally treated patient in dollars. The x axis shows the cost of the clinical event or TEE. Above the 0 baseline is more costly for TEE, and below the baseline is less costly for TEE. The star points to the actual difference in treatment costs.