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Stakeholder Insight: Atrial Fibrillation

Limited efficacy and poor safety lead to bleak outlook

Publication Date   October 2006
Publisher   Datamonitor
Product Type   Report
Pages   235
ISBN Number   not applicable
Product Code   DAT061
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Price £8,000.00

approximately: $14,126 | €10,144

Summary


Introduction

Datamonitor estimates that there are over 11 million atrial fibrillation patients in the seven major markets. Despite high unmet needs and limitations of all the current treatment options, achievement of regulatory approval is becoming increasingly difficult. This means that a very limited number of novel treatments are expected to be introduced in the near future.

Scope

  • Review of the available epidemiology data to assess the patient population of atrial fibrillation and to segment the patient population by type
  • Outline of the existing therapy options and current prescribing trends
  • Assessment of the current status of the rhythm versus rate control debate and the determining factors for each type of treatment strategy
  • Evaluation of the current usage of cardiac rhythm devices and ablation techniques to determine their future role in atrial fibrillation management

Highlights

The rapid increase in atrial fibrillation prevalence is driven by a number of factors, namely ageing population, the obesity epidemic, better prevention of strokes, and better survival of patients with cardiac disease.

There are numerous unmet needs associated with every treatment option available. The main unmet needs of pharmacological therapy are insufficient efficacy and poor safety. Non-pharmacological therapy has severe limitations, among them the cost of the procedures and the fact that a limited number of patients are eligible for it.

Despite the desperate need for a new efficacious and safe antiarrhythmic, no new drug that would significantly impact atrial fibrillation management is going to appear in the nearest future.

Reasons to Purchase

  • Target physicians more effectively, through an understanding of treatment options and their prescription choices
  • Assess the potential of each treatment option in the management of atrial fibrillation and understand the dynamics of the market
  • Recognize lucrative target populations, in terms of unmet need and patient potential, in order to successfully position developmental products

Content


  • Chapter 1 Executive Summary
    • Scope of the analysis
    • Datamonitor insight into the AF market
    • The rapid increase in AF prevalence is driven by a number of factors, namely ageing population, the obesity epidemic, better prevention of strokes, and better survival of patients with cardiac disease.
    • A change in the definition of AF used by epidemiologists
    • The growing proportion of ageing population
    • The current "obesity epidemic"
    • Better prevention and treatment options for patients with heart disease
    • Stroke prevention and treatment strategies
    • Advanced technologies driving diagnosis rates
    • There are numerous unmet needs associated with every treatment option available. The main unmet needs of pharmacological therapy are insufficient efficacy and poor safety. Non-pharmacological therapy has severe limitations, among them the cost of the procedures and the fact that a limited number of patients is eligible for it.
    • Despite the desperate need for a new efficacious and safe antiarrhythmic, no new drug that would significantly impact the AF management is going to appear in the nearest future.
    • The unresolved unmet needs put significant pressure on the more widespread use of non-pharmacological treatment options. The usage of electrical cardioversion is steadily growing, despite the guidelines, and due to several advantages of direct current cardioversion over pharmacological cardioversion. Also, pulmonary vein isolation as the only viable curative option, while not very widespread now, is becoming an attractive option for certain patient types, and may gain use, despite being still in development.
    • Key metrics
  • Chapter 2 Introduction And Scope
    • Coverage of the Atrial Fibrillation Stakeholder Insight Survey
  • Chapter 3 Country Treatment Trees
    • Introduction to the treatment trees
  • Chapter 4 Epidemiology & Patient Segmentation
    • Definition of the disease
    • Classification of AF
    • Epidemiology of disease
    • Methodology
    • US
    • Japan
    • Europe: UK
    • Europe: France, Germany, Italy and Spain
    • Lone atrial fibrillation
    • Co-morbidities, complications and risk factors
    • Hypertension and AF
    • Heart failure and atrial fibrillation
    • Complications
    • Stroke
  • Chapter 5 Diagnosis & Treatment Options
    • Diagnosis
    • Untreated AF patients
    • Treatment options
    • Antiarrhythmic drugs
    • Class I agents
    • Class Ia
    • Class Ic
    • Class II agents - Beta blockers
    • Class III agents
    • Sotalol
    • Amiodarone
    • Dofetilide
    • Diltiazem
    • Verapamil
    • Digoxin
  • Chapter 6 Prescribing Trends And Influencing Factors
    • Introduction to treatment guidelines
    • Cardioversion
    • Pharmacological cardioversion
    • Electrical cardioversion
    • Cardioversion: success rates
    • Antiarrhythmic drug therapy strategies
    • The rate versus rhythm debate
    • Drug therapy for sinus rhythm control
    • Outcome of antiarrhythmic drug therapy for rhythm control
    • Drug therapy for rate control
    • Outcome of rate control drugs
    • Cardiac rhythm management (CRM) devices
    • Pacemakers
    • Overdrive atrial pacing
    • Implantable cardioverter-defibrillators (ICDs)
    • Shock intolerance issue with ICDs
    • Pharmacoeconomics
    • Adjunctive drug therapies used with devices
    • Catheter ablation
    • Atrioventricular node or junction ablation
    • Pulmonary vein isolation/ablation
    • Success rates of catheter ablation
    • Success rates: catheter ablation versus drug therapy
    • Surgical procedures
    • Overview of AF treatment for all AF types
    • Recent onset AF
    • Paroxysmal AF
    • Persistent and permanent AF
    • Treatment guidelines for special cases
    • Heart failure
    • Coronary artery disease
    • Hypertensive heart disease
    • Post-operative therapy
    • Prevention options
    • Postoperative treatment options
  • Chapter 7 Improving Treatment Outcomes
    • Treatment outcomes
    • Rhythm versus rate control
    • Cardioversion
    • Ablation
    • Cardiac rhythm devices
    • Unmet needs in AF
    • Efficacy
    • Quality of life
    • Treatment Options for AF patients with underlying heart disease
    • Decreased mortality
    • Safety
    • New product development - Antiarrhythmics
    • Dronedarone (Multaq)
    • Azimilide
    • RSD1235 (intravenous formulation)
    • Pulzium (tedisamil) (intravenous formulation)
    • Future focus
  • Appendix A
    • Bibliography
    • Epidemiology
    • General and clinical trial data
  • Appendix B
    • QUESTIONnaIRE
    • 1. Presentation And Diagnosis Rates
    • 2. Cardioversion
    • 3. Management Of Atrial Fibrillation
    • 4 Antiarrhythmic Drug Therapy
    • 5 Antiarrhythmic Drug Therapy For Sinus Rhythm Maintenance
    • 6 Antiarrhythmic Drug Therapy For Ventricular Rate Control
    • 7 Implantable Cardiac Rhythm Devices
    • 8 Catheter Ablation Procedures
    • 9 Unmet Needs in the Treatment of Atrial Fibrillation
  • Physician Sample Breakdown
    • US
    • Japan
    • France
    • Germany
    • Spain
    • Italy
    • UK
    • Disclaimer
  • List of Tables
    • Table1: Prevalenceestimatesforatrialfibrillation,2006-2014
    • Table 2: Prevalence estimates for Atrial Fibrillation, 2006-2015, 000s
    • Table 3: Proportion of AF patients with common co-morbidities and risk factors (%)
    • Table 4: Percentage prevalence of co-morbidity in elderly AF patients
    • Table 5: Major side effects of antiarrhythmic drugs
    • Table 6: SAFE-T: median time to AF recurrence in days
    • Table 7: Percentage of AF patients receiving the following antiarrhythmic classes or drugs for rhythm control
    • Table 8: Factors effecting choice of first-line therapy for rhythm control (rated on the scale from 1 to 10, where 10 means most influential factor)
    • Table 9: Percentage of AF patients receiving the following antiarrhythmic drugs for rate control
    • Table 10: Factors effecting choice of first-line therapy for rate control
    • Table 11: Average direct costs of care for pacemaker and ICD implantation in Canada, 1997-98
    • Table 12: The mean success rates for each type of catheter ablation (%)
    • Table 13: A4: Primary and Secondary Endpoints at 12 Months
    • Table 14: Treatment outcomes
    • Table 15: US physician sample breakdown, 2006
    • Table 16: Japan physician sample breakdown, 2006
    • Table 17: France physician sample breakdown, 2006
    • Table 18: Germany physician sample breakdown, 2006
    • Table 19: Spain physician sample breakdown, 2006
    • Table 20: Italy physician sample breakdown, 2006
    • Table 21: UK physician sample breakdown, 2006
  • List of Figures
    • Figure 1: Total AF population treated with antiarrhythmic drugs
    • Figure 2: Diagrammatic overview of the coverage of the AF Stakeholder Insight Survey, 2006
    • Figure 3: A breakdown of AF population in the US by type, and method of diagnosis, 2006
    • Figure 4: A breakdown of AF population in the US by treatment and success rates, 2006
    • Figure 5: A breakdown of AF population in the US by treatment and strategy, 2006
    • Figure 6: A breakdown of AF population in Japan by type, and method of diagnosis, 2006
    • Figure 7: A breakdown of AF population in Japan by treatment and success rates, 2006
    • Figure 8: A breakdown of AF population in Japan by treatment and strategy, 2006
    • Figure 9: A breakdown of AF population France by type, and method of diagnosis, 2006
    • Figure 10: A breakdown of AF population in France by treatment and success rates, 2006
    • Figure 11: A breakdown of AF population in France by treatment and strategy, 2006
    • Figure 12: A breakdown of AF population in Germany by type, and method of diagnosis, 2006
    • Figure 13: A breakdown of AF population in Germany by treatment and success rates, 2006
    • Figure 14: A breakdown of AF population in Germany by treatment and strategy, 2006
    • Figure 15: A breakdown of AF population in Italy by type, and method of diagnosis, 2006
    • Figure 16: A breakdown of AF population in Italy by treatment and success rates, 2006
    • Figure 17: A breakdown of AF population in Italy by treatment and strategy, 2006
    • Figure 18: A breakdown of AF population in Spain by type, and method of diagnosis, 2006
    • Figure 19: A breakdown of AF population in Spain by treatment and success rates, 2006
    • Figure 20: A breakdown of AF population in Spain by treatment and strategy, 2006
    • Figure 21: A breakdown of AF population in the UK by type, and method of diagnosis, 2006
    • Figure 22: A breakdown of AF population in the UK by treatment and success rates, 2006
    • Figure 23: A breakdown of AF population in the UK by treatment and strategy, 2006
    • Figure 24: The structure of the human heart
    • Figure 25: ECGs of normal heart rhythm and atrial fibrillation
    • Figure 26: Classification of AF
    • Figure 27: Prevalence of the different types of AF across the AF population
    • Figure 28: Percentage of AF population with lone AF
    • Figure 29: Percentage of severe HF patients within total AF population
    • Figure 30: Percentage of AF patients diagnosed with each diagnostic method
    • Figure 31: Percentage of AF population that remain untreated for AF
    • Figure 32: Overview of treatment guidelines
    • Figure 33: Antiarrhythmic drug classes and contraindications
    • Figure 34: Guideline recommendations for drugs for pharmacological cardioversion
    • Figure 35: Treatment guidelines for cardioversion in AF patients
    • Figure 36: Percentage of AF patients undergoing each type of cardioversion
    • Figure 37: Percentage of AF patients undergoing the following number of cardioversions during their arrhythmia lifetime
    • Figure 38: Percentage of cardioversion patients maintaining sinus rhythm at one year
    • Figure 39: Percentage of recent onset AF population treated with either rhythm or rate control therapy
    • Figure 40: Percentage of paroxysmal AF population treated with either rhythm or rate control therapy
    • Figure 41: Percentage of persistent AF population treated with either rhythm or rate control therapy
    • Figure 42: Percentage of permanent AF population treated with either rhythm or rate control therapy
    • Figure 43: Percentage of AF patients with each type of AF that receive rate control therapy
    • Figure 44: Average ratings of each AF patient population benefiting from sinus rhythm maintenance (ranked from 1 to 13, where 1 means "great benefit")
    • Figure 45: Average ratings of each AF patient population benefiting from ventricular rate control (ranked from 1 to 14, where 1 means "great benefit")
    • Figure 46: Percentage of rhythm control patients not treated successfully at first line
    • Figure 47: Percentage of AF patients treated for sinus rhythm maintenance that change therapy for the following reasons
    • Figure 48: Percentage of rhythm patients that switch to rate control therapy
    • Figure 49: Percentage of rate control patients not treated successfully at first line
    • Figure 50: Percentage of AF patients treated for ventricular rate control that change therapy for the following reasons
    • Figure 51: Percentage of all patients not treated successfully at first-line
    • Figure 52: Percentage of AF population receiving CRM devices
    • Figure 53: Percentage of AF population receiving each type of device
    • Figure 54: Standard therapies given with Dual Chamber Pacemakers without AF Suppression Algorithms
    • Figure 55: Standard therapies given with Dual Chamber Pacemakers with AF Suppression Algorithms
    • Figure 56: Standard therapies given with Dual Chamber Implantable Cardioverter Defibrillator
    • Figure 57: Standard therapies given with Single Chamber (Ventricular) Pacemakers
    • Figure 58: Percentage of AF patients that have undergone catheter ablation
    • Figure 59: Percentage of patients undergoing each type of catheter ablation
    • Figure 60: Percentage of AF patients undergoing catheter and surgical ablation
    • Figure 61: Percentage of AF patients receiving the following therapies
    • Figure 62: Overview of treatment guidelines for recent onset AF
    • Figure 63: Overview of treatment guidelines for paroxysmal AF
    • Figure 64: Overview of treatment guidelines for persistent and permanent AF
    • Figure 65: Treatment guidelines for patients with heart disease
    • Figure 66: Unmet needs of AF (ranked from 1 to 15, where 1 means "most important")
    • Figure 67: The most important unmet needs in AF