Condition

Atrial Fibrillation

Irregular heart rhythm

52.6M
People Affected
150
Active Trials
4.5M
New Cases/Year
339K
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Apixaban
90% Effectiveness• 95% Confidence• 65% Safety• 177 trials• 70K participants
HIGH EvidenceGood ValueDose: 5 mg twice daily (or 2.5 mg twice daily for specific criteria)
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Comparative Safety Scale(Higher is safer)

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65
DangerousModerateSafe

Time to Effect

Immediate (within hours)

Duration

Lifetime

Response Rate

%

Remission Rate

%

Number Needed to Treat (NNT)

40

Number Needed to Harm (NNH)

100

Common Side Effects:

Minor bleeding (epistaxis, bruising): 15%
Major bleeding (gastrointestinal, intracranial): 2%
Gastrointestinal upset: 7%

Annual Cost of Care

Drug Cost

$5,500

Monitoring

$150

Side Effects

$750

Total Annual

$6,400

Cost-Effectiveness

GOOD

QALYs Gained

0.6

ICER

$40,000/QALY

Treatment Outcomes
Primary Outcomes
Ischemic Stroke or Systemic Embolism RateAnnualized event rate (Warfarin arm): 1.89%
-33% (-0.62% per year)
Major Bleeding RateAnnualized event rate (Warfarin arm): 3.09%
-31% (-0.96% per year)
All-Cause Mortality RateAnnualized event rate (Warfarin arm): 3.94%
-11% (-0.42% per year)
Intracranial Hemorrhage RateAnnualized event rate (Warfarin arm): 0.74%
-68% (-0.50% per year)
Secondary Benefits
Net Clinical Benefit (Composite of Stroke, Systemic Embolism, Major Bleeding, or All-Cause Death)Annualized event rate (Warfarin arm): 7.15%
-16% (-1.16% per year)
Major or Clinically Relevant Non-Major Bleeding RateAnnualized event rate (Warfarin arm): 6.94%
-41% (-2.87% per year)
Common Side Effects
Minor bleeding (epistaxis, bruising)
+15%
Major bleeding (gastrointestinal, intracranial)
+2%
Gastrointestinal upset
+7%

Clinical Trial Phases:

Phase 4
2
Metoprolol
80% Effectiveness• 95% Confidence• 70% Safety• 31 trials• 300K participants
HIGH EvidenceExcellent ValueDose: Metoprolol succinate 25-200 mg daily
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Comparative Safety Scale(Higher is safer)

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Meth💀
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70
DangerousModerateSafe

Time to Effect

1-3 days

Duration

Lifetime

Response Rate

85%

Remission Rate

%

Number Needed to Treat (NNT)

3

Number Needed to Harm (NNH)

15

Common Side Effects:

Fatigue: 12%
Bradycardia: 7%
Dizziness: 7%
Hypotension: 5%

Annual Cost of Care

Drug Cost

$75

Monitoring

$400

Side Effects

$100

Total Annual

$575

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.3

ICER

$5,000/QALY

Cost per Responder

$676

Treatment Outcomes
Primary Outcomes
Resting Ventricular Rate115 bpm
-30% (-35 bpm)
Exertional Ventricular Rate160 bpm
-31% (-50 bpm)
Atrial Fibrillation Symptom Scale (AFSS) ScoreAFSS score: 25/42
-40% (-10 points)
Secondary Benefits
Quality of Life (EQ-5D Visual Analogue Scale)EQ-5D VAS: 60/100
+15% (+9 points)
Exercise Tolerance (6-Minute Walk Test)300 meters
+20% (+60 meters)
AFib-related Hospitalizations/Emergency Department Visits1.5 visits/year
-67% (-1 visit/year)
Common Side Effects
Fatigue
+12%
Bradycardia
+7%
Dizziness
+7%

Clinical Trial Phases:

Phase 4
3
Catheter Ablation
75% Effectiveness• 90% Confidence• 60% Safety• 869 trials• 50K participants
HIGH EvidenceGood Value
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Comparative Safety Scale(Higher is safer)

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60
DangerousModerateSafe

Time to Effect

3-6 months for full effect assessment

Duration

Single procedure, possibly repeat

Response Rate

75%

Remission Rate

65%

Number Needed to Treat (NNT)

4

Common Side Effects:

Groin hematoma/bleeding: 3%
Cardiac tamponade: 1.5%
Stroke/TIA: 0.5%
Pericarditis: 3%

Annual Cost of Care

Drug Cost

$0

Monitoring

$1,500

Side Effects

$500

Total Annual

$9,000

Cost-Effectiveness

GOOD

QALYs Gained

0.2

ICER

$55,000/QALY

Cost per Remission

$13,846

Cost per Responder

$12,000

Treatment Outcomes
Primary Outcomes
Atrial Fibrillation BurdenMean AF burden: 40% (percentage of time in AF)
-85% (-34 percentage points)
Atrial Fibrillation Symptom Severity (EHRA Scale)EHRA score: 2.5/4
-60% (-1.5 points)
Proportion of Patients Requiring Antiarrhythmic Drugs100%
-60% (-60 percentage points)
Atrial Fibrillation-Specific Quality of Life (AFEQT Score)AFEQT total score: 60/100
+33.3% (+20 points)
Secondary Benefits
6-Minute Walk Distance (6MWD)350 meters
+12% (+42 meters)
Left Atrial Volume Index (LAVI)38 mL/m^2
-12% (-4.6 mL/m^2)
Hospitalizations for Atrial Fibrillation0.5 hospitalizations per patient-year
-70% (-0.35 hospitalizations per patient-year)
Common Side Effects
Groin hematoma/bleeding
+3%
Cardiac tamponade
+1.5%
Stroke/TIA
+0.5%

Clinical Trial Phases:

Phase 4
4
Amiodarone
70% Effectiveness• 90% Confidence• 50% Safety• 150 trials• 40K participants
HIGH EvidenceGood ValueDose: Loading dose 600-1200 mg/day for 1-2 weeks, then 100-400 mg/day maintenance
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Comparative Safety Scale(Higher is safer)

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50
DangerousModerateSafe

Time to Effect

1-3 weeks

Duration

Lifetime

Response Rate

60%

Remission Rate

50%

Number Needed to Treat (NNT)

5

Number Needed to Harm (NNH)

8

Common Side Effects:

Thyroid dysfunction: 17%
Liver dysfunction: 17%
Corneal microdeposits: 90%
Pulmonary toxicity: 7%
Gastrointestinal upset: 12%

Annual Cost of Care

Drug Cost

$200

Monitoring

$1,500

Side Effects

$1,000

Total Annual

$2,700

Cost-Effectiveness

GOOD

QALYs Gained

0.15

ICER

$45,000/QALY

Cost per Remission

$5,400

Cost per Responder

$4,500

Treatment Outcomes
Primary Outcomes
Atrial Fibrillation Recurrence RateFrequent episodes (e.g., 50% recurrence at 1 year)
-60% (Reduced by 50-70% of baseline recurrence rate)
AF-related Symptom BurdenEHRA score 2.5 (moderate symptoms)
-40% (Reduced by 1.0 points on EHRA scale)
Ventricular Rate during Atrial Fibrillation130 bpm (uncontrolled AF)
-35% (-45 bpm)
Secondary Benefits
Quality of Life (AF-specific scale)AF-QoL score 60/100 (moderate impairment)
+25% (+15 points on AF-QoL scale)
Exercise Tolerance (6-Minute Walk Test)300 meters
+12% (+36 meters)
Heart Failure Hospitalization RateElevated risk (e.g., 15% annual rate)
-25% (Reduced by 25% of baseline annual rate)
Common Side Effects
Thyroid dysfunction
+17%
Liver dysfunction
+17%
Corneal microdeposits
+90%

Clinical Trial Phases:

Phase 4
5
Sotalol
68% Effectiveness• 88% Confidence• 52% Safety• 40 trials• 30K participants
HIGH EvidenceGood ValueDose: 80-160 mg twice daily
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Comparative Safety Scale(Higher is safer)

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52
DangerousModerateSafe

Time to Effect

2-4 days

Duration

Lifetime

Response Rate

58%

Remission Rate

48%

Number Needed to Treat (NNT)

6

Number Needed to Harm (NNH)

40

Common Side Effects:

Fatigue: 12%
Bradycardia: 7%
QT prolongation / Torsades de Pointes: 2%
Dizziness: 10%

Annual Cost of Care

Drug Cost

$200

Monitoring

$1,000

Side Effects

$500

Total Annual

$1,700

Cost-Effectiveness

GOOD

QALYs Gained

0.1

ICER

$40,000/QALY

Cost per Remission

$3,542

Cost per Responder

$2,931

Treatment Outcomes
Primary Outcomes
Time to First Atrial Fibrillation Recurrence90 days
+60% (+54 days)
Atrial Fibrillation Episode Frequency4.0 episodes/month
-55% (-2.2 episodes/month)
Atrial Fibrillation Symptom Burden (EHRA Scale)EHRA Score: 2.8 (scale 1-4)
-35% (-1.0 point)
Resting Heart Rate (in Sinus Rhythm)78 bpm
-10% (-8 bpm)
QTc Interval420 ms
+8% (+34 ms)
Secondary Benefits
Atrial Fibrillation Effect on Quality of Life (AFEQT)AFEQT Score: 60/100
+15% (+9 points)
Hospitalizations for Atrial Fibrillation0.5 events/year
-60% (-0.3 events/year)
6-Minute Walk Test Distance350 meters
+10% (+35 meters)
Common Side Effects
Fatigue
+12%
Bradycardia
+7%
QT prolongation / Torsades de Pointes
+2%

Clinical Trial Phases:

Phase 4
6
Flecainide
65% Effectiveness• 85% Confidence• 55% Safety• 48 trials• 20K participants
HIGH EvidenceGood ValueDose: 50-150 mg twice daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
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55
DangerousModerateSafe

Time to Effect

1-2 days

Duration

Lifetime

Response Rate

55%

Remission Rate

45%

Number Needed to Treat (NNT)

5

Number Needed to Harm (NNH)

15

Common Side Effects:

Dizziness: 15%
Visual disturbances: 10%
Proarrhythmia (ventricular tachycardia/fibrillation): 3%
Nausea: 7%

Annual Cost of Care

Drug Cost

$200

Monitoring

$750

Side Effects

$500

Total Annual

$1,450

Cost-Effectiveness

GOOD

QALYs Gained

0.1

ICER

$40,000/QALY

Cost per Remission

$3,222

Cost per Responder

$2,636

Treatment Outcomes
Primary Outcomes
Annualized Atrial Fibrillation Recurrence Rate1.5 episodes per year
-60% (-0.9 episodes per year)
Percentage of Time in Atrial Fibrillation (AF Burden)18% of total monitoring time
-65% (-11.7% of total monitoring time)
Atrial Fibrillation Symptom Severity Score (e.g., EHRA scale, 1-4)EHRA score: 3.1
-40% (-1.24 points)
Secondary Benefits
SF-36 Physical Component Summary (PCS) ScoreSF-36 PCS Score: 40/100
+15% (+6 points)
Annual Number of Electrical Cardioversions0.7 electrical cardioversions per year
-75% (-0.53 cardioversions per year)
Annual Number of Emergency Department Visits for AF0.4 visits per year
-60% (-0.24 visits per year)
Common Side Effects
Dizziness
+15%
Visual disturbances
+10%
Proarrhythmia (ventricular tachycardia/fibrillation)
+3%

Clinical Trial Phases:

Phase 4