Number of Ablations performed UK/US

[CDreamer]

On a recent thread there was some discussion about the difference between countries regarding access to EP’s and ablations, so I decided to do a bit of research based on statistics rather than perceptions and so far this is what I found out:-

UK does fewer ablations than rest of Europe, based on statistics from 2016-2017

US does approximately 75,000 ablations per year, which considering the difference of size of population is probably percentage wise less than the 20,000 or so that happened in the UK.

US population = 332 Million. UK population = 66Million.

Sources:- nicor.org.uk/wp-content/upl...

I found it quite difficult to find collated data on the actual numbers as, not surprisingly, studies are more interested in the efficacy of the procedure.

Just saying,

[BobD Volunteer]

Interesting statisics CD. Not actually surprised at the lower % in US as of course you need to be rich or well insured over there whereas anybody deemed suitable can have an ablation in UK inder our NHS. Do we know % in Europe at all? We do know that the number of EPs per populace is lower but that is the same with most specialities. EG there are more skin cancer specialists in Berlin than the whole of South West of UK I was told.

[belindalore in reply to BobD]

You are right about having to be rich or have the good insurance here in the USA. And that pertains to many procedures. Not just Afib. If you don't have the money or the good insurance you will fall through the cracks and not offered a needed procedure. I have mitral valve regurgitation. And my Dr told me my insurance probably wouldn't pay for surgery. Just give me meds. Made me feel like my life doesn't matter. I've known people much older than I am (69) who have had surgery for mitral valve. The healthcare system is not great here like the USA wants the rest of the world to believe. People die here everyday because they can't afford insurance or the insurance they can afford isn't enough. It's a travesty that this should happen. Disheartening. And it's just getting worse.

[Madscientist16 in reply to BobD]

I am in the US. Luckily I have insurance, but I also was a good candidate for an ablation. I had a battery of tests and did not need to fulfill lifestyle changes (i.e. weight, diet, alcohol, smoking, etc) to see if it reduced my AF burden. When medication didn't work for me, insurance finally approved the ablation.

[CDreamer in reply to Madscientist16]

That’s interesting - so you had drugs and when they failed, ablation? When I say Lifestyle I mean more than you mentioned - Sleep, Stress, Exercise and Nutrition. It’s as much about what you do as what you avoid.

[Madscientist16 in reply to CDreamer]

I guess I should have clarified better. When I said I did not need to fulfill lifestyles changes it was because I already had a healthy diet and at a healthy weight. I exercised daily and did not smoke or drink caffeine or alcohol. They also tested me for sleep apnea. The insurance company was NOT going to pay for an ablation if I was overweight, heavy smoker, etc. They would have wanted me to improve my lifestyle to see if that reduced my AF burden first. After about 2 years, when medication did not work, they approved the ablation. It was either that or continue to pay for my hospital visits.

[Hidden]

Hello CD, I am useless at interpreting these reports but fig 2.8 on page 10 shows an annual figure of around 8000 for AF ablations (RF & Cryoablation) which is around the figure BobD quoted some months ago. I haven’t read the whole report so I may of got it wrong so as you said, just saying 😉

[CDreamer in reply to Hidden]

Total no of ablations - not just for AF.

[Hidden in reply to CDreamer]

Ahh.....thanks

[etheral]

Perhaps the fewer number of ablations for afib relatively in the US is related to the availability of efficacious drugs not available in the UK.

[CDreamer in reply to etheral]

I don’t know - can you give an example? We use the Generic names but as far as I am aware they are the same drugs with different names.

[etheral in reply to CDreamer]

Tikosyn brand name, dofetilide (generic).. has kept me in NSR for 3 years, fingers crossed 😏.... my EP says she has had good success with it....

[CDreamer in reply to etheral]

Certainly that is not available in Europe or Australia. Pfitzer got approval in Europe and then voluntarily withdrew it from the market, one assumes for commercial reasons. I remember my EP mentioning it but was of the opinion that it wasn’t that much more efficacious as Amiodarone, although not as toxic.

As many countries in Europe have social healthcare systems, often unless a drug is remarkably superior or unique then it is commercially nonviable for a company to market as collective buying policies reduces their profit margins. Needless to say the companies don’t like that.

In UK the quango that look at and recommend all treatments is NICE = National Institute for Health and Care Excellence so often funding for any drug which is not recommended by NICE is controversial and not often funded so difficult to come by.

[MarkS]

A key difference from a previous report I saw was that the number of ablation performed by EPs in the US was surprisingly low. To be effective, an EP needs to perform at least 100 p.a. In the US the average was around 20 or so. The top EPs in the UK do about 150-200. I'll see if I can find the report later.

[CDreamer in reply to MarkS]

I think I saw that report which recommended that to keep competence EPs need to perform at least 50/pa.

[Singwell]

Interesting! Maybe we get the impression that more are done in the US because we only read about the % of the population who have sufficient health cover. Sobering. I'm not surprised about the EU - I have friends in Austria, The Netherlands and Sweden and they seem to offer ablation almost as routine - less wait too.

[Maggimunro]

Hi thereI have two brothers. One in the USA, the other in France. Both were diagnosed with AFib during routine health checks just a year after I was. Both were asymptomatic, unlike me. My French brother was given an ablation ASAP whereas the procedure wasn’t even mentioned for my American brother and he is now on several different drugs.

I cannot help but wonder if this simply reflects the two vastly different health care systems. I doubt my American brother would have sufficient health care cover or liquid assets to cover the cost in the States (not without selling his home). France on the other hand has a brilliant, free at the point of need health care system, plus this brother would have had full additional health care cover if he chose ro go into a private clinic.

I thank my lucky stars that we still have our NHS, although for how much longer it will be free at the point of need is highly debatable.

[CDreamer in reply to Maggimunro]

Good illustration of realities of the various systems & who gets offered ablation & who not. I know that if it were the decision many EPs of who to ablate ASAP, there wouldn’t be waiting lists but alas, resources need to be shared.

[belindalore in reply to Maggimunro]

You should convince your brother in the USA to move to France or the UK. Health care in the USA is only going to get worse. People who are US citizens can't get healthcare. Yet the illegals coming in are. And many many of these illegals are coming in infected with covid and other diseases. AND they have been let go into the general population! The USA has lost its mind under the new administration. If I had lots of money I would leave. This country is so out of control it's not far from imploding. Maybe it's what it deserves.

[CDreamer in reply to belindalore]

Oh dear Belindalore, you sound quite despairing. Unfortunately it seems that Europe also has similar problems so I don’t think there is an ideal administration - they all seem to have their problems.

[belindalore in reply to CDreamer]

Maybe as some people say-the end is near. The USA has a society that is becoming more and more like the Roman civilization. And the Romans eventually were no more. It will not happen in my lifetime but I do believe it will happen. There was a psychic in the USA. She predicted many things that would happen in the future. She passed away a few years ago. One of the last questions she was asked was what did she see in the future. She said she saw nothing after the year 2100. Only darkness. The shape the world is in now, she may very well have been right. I didn't have children. I feel bad for anyone who has children and grandchildren. I shudder to think what they may face.