{"id":"bf5f95060061","type":"article","url":"https://hartvaat.nl/2026/12/15/afbouwen-hartfalenmedicatie-bij-herstelde-af-medieerde-cardiomyopathie-withdraw-/","title":"Afbouwen hartfalenmedicatie bij herstelde AF-mediëerde cardiomyopathie — WITHDRAW-AF","title_en":"Cost-effectiveness of heart failure pharmacotherapy withdrawal in recovered atrial fibrillation mediated cardiomyopathy: analysis of the WITHDRAW-AF randomized clinical trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"International journal of cardiology","doi":"10.1016/j.ijcard.2026.134943","source_url":"https://doi.org/10.1016/j.ijcard.2026.134943","authors":["Kenneth K Cho","Derek P Chew","Hariharan Sugumar","Liang-Han Ling","Aleksandr Voskoboinik","Christopher Reid","Jonathan M Kalman","Peter M Kistler","Louise Segan","Sandeep Prabhu"],"significance":5,"published":"2026-11-03","source_date":"2026-12-15","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"The economic analysis of the WITHDRAW-AF randomised trial evaluated whether withdrawing heart failure pharmacotherapy is cost-effective in carefully selected patients with recovered atrial fibrillation-mediated cardiomyopathy following ablation. Over five years, withdrawal proved cost-minimising with projected costs of $3,901 versus $8,446 for continuation, while functional capacity (6MWT, VO2max) and quality of life remained comparable. These findings provide cardiologists and internists with an evidence-based framework to de-escalate therapy in this specific subgroup, reducing polypharmacy and healthcare costs without clinical detriment.","created":"2026-10-28T01:54:28Z","updated":"2026-10-28T01:54:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De economische analyse van de WITHDRAW-AF-randomisatie onderzocht of het afbouwen van hartfalenmedicatie rendabel is bij zorgvuldig geselecteerde patiënten met een herstelde AF-mediëerde cardiomyopathie na ablatie. Over vijf jaar bleek afbouwen kostenefficiënt met geprojecteerde kosten van $3.901 versus $8.446 voor continuatie, terwijl functioneel vermogen (6MWT, VO2max) en levenskwaliteit gelijk bleven. Dit biedt cardiologen en internisten een evidence-based kader om medicatie te de-escaleren bij deze specifieke patiëntengroep, wat polyfarmacie en zorgkosten kan verminderen zonder klinisch nadeel.","abstract_original":"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."}