Healthcare Utilization and Outcomes in Atrial Fibrillation Patients Treated by Drug Therapy versus a Catheter Ablation Strategy-A Middle European Propensity Score Matched Cohort Study

BACKGROUND AND AIMS: Atrial fibrillation (AF) is the most prevalent arrhythmia, associated with increased mortality and morbidity and causing relevant costs. Treatment options consist of catheter ablation (PVI) and rate or rhythm control drugs (non-PVI). METHODS: We analyze inpatient and outpatient data from the Upper Austrian Health Insurance Fund. Data of patients with a first hospitalization for AF in the years 2005 to 2018 were examined, using propensity score matching (PSM) including all CHA2DS2-VASc variables and working "collar". RESULTS: Out of 21,791 AF patients, PSM identified 1013 well-matching pairs (PVI and non-PVI). Over a ten-year period, the PVI treatment strategy group reveals significantly higher inpatient and outpatient expenditures (€2200/year). Positive economic effects can be demonstrated by a 5.1 percentage points (pp) higher employment rate and fewer retirements (7.6pp). Of utmost important is the 5.8pp all-cause mortality reduction over 10 years in the PVI treatment strategy. CONCLUSIONS: A PVI based treatment strategy results in higher healthcare expenditures vs. drug therapy alone. Most of these higher costs were caused by the PVI procedures during this period. Thus, more effective and efficient methods are needed to further reduce costs for the intervention and prevent repeat procedures. The benefit of a PVI treatment strategy is seen in higher employment rates, which are crucial from a societal perspective and should be a strong argument for caregivers. We show a significant reduction in all-cause mortality, which we partly attribute to the PVI procedure itself, to a stricter risk factor assessment and treatment, and a tighter medical adherence

Do Local Landscape Patterns Affect the Demand for Landscape Amenities Protection?

Agricultural support is increasingly flowing into the maintenance and improvement of landscape quality. While variations in the demand for landscape protection have been successfully attributed to variations in socio-economic characteristics, the effect of the local landscape setting as a potential determinant of environmental preferences has received less attention. A framework is formulated that describes public support for regional landscape protection as a function of socio-economic variables and land use patterns. Models are then estimated using detailed local land use statistics and voting records from a referendum on increasing public funding for local landscape amenities protection in the Swiss canton of Zurich. The land use variables represent proportions of open landscape and landscape features that are viewed as particularly valuable for aesthetic and other reasons. Cross-sectional estimation results suggest that attitudes towards public landscape protection are indeed strongly associated with the local landscape. Approval for protection programmes increased with local scarcity of open space and with the presence of high-amenity landscape features. Comparison with referendum outcomes on a national-level environmental issue suggests that the positive association with high-amenity landscape features may be partly attributable to individuals' self-selection of residency