Generalizability of the CASTLE-AF trial: Catheter ablation for patients with atrial fibrillation and heart failure in routine practice.

Heart Rhythm : the Official Journal of the Heart Rhythm Society
Peter A NoseworthyXiaoxi Yao

Abstract

In the Catheter Ablation for Atrial Fibrillation with Heart Failure (CASTLE-AF) trial, catheter ablation reduced the risk of death and heart failure (HF) hospitalization in patients with atrial fibrillation and HF by 40%. The study aimed to assess the generalizability of CASTLE-AF to routine clinical practice. Using a large US administrative database, we identified 289,831 patients with atrial fibrillation and HF treated with ablation (n = 7465) or medical therapy alone (n = 282,366) from January 1, 2008, through August 31, 2018. Patients were divided into 3 groups on the basis of trial eligibility: (1) eligible for CASTLE-AF, (2) failing to meet the inclusion criteria, and (3) meeting at least 1 of the exclusion criteria. Propensity score overlap weighting was used to balance ablated and drug-treated patients on 90 baseline characteristics. Cox proportional hazards regression was used to compare ablation with medical therapy for the primary outcome of a composite end point of all-cause mortality and HF hospitalization. Only 7.8% of patients would have been eligible for the trial; 91.0% failed to meet the trial inclusion criteria; and 15.5% met the exclusion criteria. Ablation was associated with a lower risk of the primary out...Continue Reading

Citations

Jul 11, 2020·Current Cardiology Reports·Gregory Burkman, Gerald V Naccarelli
Oct 7, 2020·Journal of Cardiovascular Electrophysiology·Michael E FieldDaniel J Friedman
Dec 8, 2020·Circulation. Cardiovascular Quality and Outcomes·Derek S ChewJonathan P Piccini
Oct 17, 2020·Medical Devices : Evidence and Research·Agnieszka KotalczykGregory Y H Lip
Dec 15, 2020·Clinical Cardiology·Jiameng RenSiqi Lyu
Oct 15, 2020·Nature Reviews. Cardiology·Ramanathan ParameswaranJonathan M Kalman
Mar 16, 2021·Expert Review of Cardiovascular Therapy·Agnieszka KotalczykGregory Y H Lip
Apr 6, 2021·Current Heart Failure Reports·Arianna CirasaDomenico Pecora
Aug 10, 2020·Critical Pathways in Cardiology·Mohammad H AbbasiE Kevin Heist
Jun 16, 2021·Circulation. Arrhythmia and Electrophysiology·Rakesh GopinathannairUNKNOWN American Heart Association Electrocardiography and Arrhythmias Committee and Heart Failure and Transplantation Committee of
Jul 10, 2021·Journal of the American Heart Association·Darren LauScott Klarenbach
Aug 2, 2021·Progress in Cardiovascular Diseases·Michael L BernardDaniel P Morin

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