The imperative of a Medicare AF database.

摘要

I was excited to read the fine manuscript by Ellis et al published in the current issue of Heart Rhythm, but less for the reported findings than for the implicit potential. As we are all aware, atrial fibrillation (AF) is an accruing epidemic which disproportionately affects the Medicare community. Despite the prevalence of this disease, our years of experience with it, and its clear association with mortality, morbidity, reduced life quality, and increased health care-related expenditure, we have as yet been unable to clearly define the whether and how of causality. In a perfect world, maintenance of sinus rhythm is certainly preferable. However, the weight of evidence accumulated thus far, based largely on pharmacotherapy, challenges the wisdom of this pursuit. In recent years, curative-intent ablation has exploded onto the scene, propelled in part by the promise of perfection. Ellis et al used compulsory data accumulated during Medicare-funded hospitalizations to chronicle this phenomenon during the years 2001-2006. However, these data address a relatively early period of ablation.