AF Ablation Liverpool and England data Derick Todd Clinical Lead EP, Devices & ICC Liverpool Heart & Chest Hospital

Background Variation in provision – for AF ablation 5-fold across UK NICOR data for ablation last published for th year / 60 centres New dataset started in April 2014 – to better understand ablation work, especially AF

EP Consultant + Ablation Numbers LHCH

UK Ablation Numbers

Ablation numbers - Geographical Variation

Ablation data - Geographical Variation

Quality of Care - Geographical Variation

AF ablation - Geographical Variation

AF Ablation Rates - European data

Referral Issues or Funding Issues A low provision of ablation for AF may relate to under-referral threshold for ablation funding Referral issues can be assessed by ratio of AF ablation to AVNRT ablation. The 6 largest English centres have rates of 2-3 i.e. 2-3 x as many AF ablations as AVNRT University Hospital South Wales – ratio = 0.74

AF Impact – Quality of Life SF-36 9 AF patients ~1 SD lower than healthy volunteers 9. Dorian P et al (2000) The impairment of health-related quality of life in patients with intermittent atrial fibrillation: implications for the assessment of investigational therapy. J Am Coll Cardiol 36:

Referral Issues or Funding Issues Cost of AF ablation (EA29Z) - £3505 (elective) Devices excluded – cost approx. £3000 Total £6500 per case LHCH service – 600 per annum = £3.9m

Cost effectiveness?

Ablation – the future in England (& Wales) NICE guidance encourages referral for ablation NHS England conscious of ablation costs – reviewing selection criteria Possible link to PROMS in future (PROMS – patient reported outcome measures)