Cost-effectiveness of heart failure pharmacotherapy withdrawal in recovered atrial fibrillation mediated cardiomyopathy: analysis of the WITHDRAW-AF randomized clinical trial
In brief
Withdrawal cuts modeled 5-year heart failure drug costs by 54%
In carefully selected patients whose atrial fibrillation-related heart failure recovered after ablation, stopping heart failure medication saved $1,031 per patient during the trial. A 5-year model projected costs of $3,901 with withdrawal versus $8,446 with continued treatment, with similar quality-adjusted life-years and no modeled loss in function or quality of life; whether these results apply beyond this selected group remains uncertain.
- Journal
- International journal of cardiology (Q1)
- Published
- 27 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Kenneth K Cho, Derek P Chew, Hariharan Sugumar, Liang-Han Ling, Aleksandr Voskoboinik, Christopher Reid, et al.
- PMID
- 42801916
- DOI
- 10.1016/j.ijcard.2026.134943
Why clinicians should know about it
- Picked for Medical Physics (top studies of the week, 4 October 2026): Randomized trial, cost-effectiveness analysis
Abstract
BACKGROUND: The WITHDRAW-AF trial demonstrated HFrEF pharmacotherapy can be safely withdrawn in carefully selected patients with recovered atrial fibrillation-mediated cardiomyopathy post-ablation. In this study, we examined the economic implications of this strategy. METHODS: We compared costs and outcomes of each strategy during the trial and through a 5-year Markov model. Functional status was assessed by VO2max and 6-min walk test distance (6MWT), and quality of life by the Minnesota Living with Heart Failure Questionnaire (MLHFQ) mapped to the EQ-5D-5L. Probabilistic sensitivity analysis was through 2000 Monte Carlo simulations. RESULTS: In-trial medication cost savings were $1031/patient ($1572 vs $2604, p < 0.001). Over 5 years, projected modelled costs for withdrawal versus continuation were $3901 (95% CI: $3852-$3950) versus $8446 (95% CI: $8375-$8517). Outcomes favoured withdrawal; 6MWT in 61.8% of simulations (difference 29.39 m, 95% CI: 23.03-35.74), VO2max in 68.1% (difference 4.02 ml/kg/min, 95% CI: 3.49-4.44), and MLHFQ in 53.7% (difference 1.71, 95% CI: 0.57-2.84). QALYs were comparable (difference 0.003, 95% CI: -0.05-0.01). CONCLUSION: In recovered atrial fibrillation-mediated cardiomyopathy, HFrEF pharmacotherapy withdrawal represented cost-minimisation without detriment to functional status or quality of life.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.