Areas of Focus
Paroxysmal Supraventricular Tachycardia (PSVT)
PSVT is caused by an abnormality in the electrical system of the heart. People with this condition have sudden and unexpected episodes of rapid heart rate that start and stop without warning.
A normal resting heart rate is between 60 and 100 beats per minute. During a SVT episode, a patients’ heart rate increases dramatically, sometimes exceeding 250 beats per minute. While experiencing an episode of SVT, symptoms may include palpitations, sweating, chest pressure or pain, shortness of breath, sudden onset of fatigue, fainting and anxiety. Symptoms experienced by PSVT patients are commonly misdiagnosed as anxiety or panic attacks, especially in women.
PSVT can appear at any time in a patient’s lifetime and may occur in otherwise healthy patients. The frequency and severity of SVT episodes vary from patient to patient and can even vary within an individual patient. Our market research shows patients living with PSVT experience a median of four to seven SVT episodes per year despite up to two-thirds of them taking daily prescription medications to prevent episodes. These episodes may last anywhere from minutes to hours and can be debilitating for patients, leaving them unable to focus on family or work. Market research also shows that, in the year of diagnosis, almost 40 percent of PSVT patients experience multiple SVT episodes per year that last more than 10 minutes, with 10 percent of episodes being reported as severe enough to warrant a trip to the hospital for treatment. After the first year of diagnosis, these percentages decrease modestly to approximately one-third of those surveyed, likely due to medication use and vagal maneuvers.
While PSVT is not typically life threatening, the uncertainty of when an episode will occur and how long it will last can significantly impact patient quality of life. Researchers have noted that up to 27 percent of patients living with PSVT stopped driving for fear of temporary loss of consciousness.
Prevalence and Incidence
PSVT affects approximately two million Americans and results in as many as 300,000 new diagnoses and over 600,000 healthcare claims in the United States per year, including emergency department visits, hospital admissions, and ablations. These estimates are based on an analysis of employer-based medical claims data for patients under age 65 and Medicare claims data for patients age 65 and older between 2008 and 2016.
Earlier published sources documenting the demographics, clinical characteristics, and epidemiology of PSVT rely on a single medical encounter confirmed by an ECG to estimate incidence and prevalence, and this may significantly underestimate the prevalence due to the episodic nature of the disease, as well as the variability in the duration of SVT episodes.
Current treatment for PSVT consumes significant healthcare resources. Our longitudinal analyses show mean annual costs per patient increase to approximately $30,000 in the year following diagnosis. Of note, catheter ablations only represent 23% of this increased spend. In addition, rates of emergency department visits and hospitalizations are 1.8 and 3.0 times higher, respectively, following diagnosis. In total, we estimate that approximately 80,000 catheter ablations and more than 150,000 ED visits/hospital admissions for PSVT occur each year, driving the majority of the approximately $3 billion spent annually in the United States on the management of PSVT.
The Current Standard of Care
The current standard of care for acute treatment of PSVT is an intravenous (IV) injection of adenosine, usually given in a hospital or emergency department. Adenosine blocks conduction over the atrioventricular (AV) node, a piece of electrical tissue in the heart, interrupting the arrhythmia and restoring the heart rate. From its administration, patients report experiencing chest tightness, flushing, and even a sense of impending death. Adenosine is eliminated from the body in less than one minute and cannot be self-administered by the patient, as it requires IV access.
Prior to the approval of adenosine, PSVT was treated with IV calcium channel blockers, such as verapamil or diltiazem, that also slow conduction over the AV node within minutes. These drugs bear risk of excessive slowing of the heart and low blood pressure. In-hospital IV administrations are associated with higher health care costs and are unsettling and inconvenient for the patient.
Many patients take daily oral medications, such as beta blockers, calcium channel blockers or antiarrhythmic drugs, in an attempt to prevent or control the frequency and duration of future SVT episodes. Even so, “breakthrough” episodes requiring visits to the emergency department do occur. Some patients discontinue oral medication due to intolerable side effects. For instance, taking beta blockers chronically may cause sexual dysfunction or fatigue, and long-term use of verapamil may cause constipation
The only potentially curative treatment for PSVT is ablation, an invasive interventional procedure, which cauterizes the short circuit causing an abnormal rhythm. This procedure burns or freezes the heart’s abnormal electrical tissue with catheters that are run through the patient’s groin vessels and into the heart. Analyses of insurance claims suggest less than 10 percent of patients living with PSVT annually resort to this.
Let’s Work Together
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