Atrial Fibrillation Increase Leading To More Hospitalizations and Higher Costs

MedicalResearch.com Interview with:
Azfar B. Sheikh, M.D.
Internal Medicine Resident Physician
Staten Island University Hospital
New York

Medical Research: What is the background for this study?

Dr. Sheikh: The background of this review article circles around the impact of
atrial fibrillation on epidemiology, trends in hospitalizations, costs
associated with hospitalization and outpatient care, in the United
States. This article also describes the benefits of newer treatment
modalities compared to the standard of care with regards to
symptomatic improvement and prevention of thromboembolism. These
findings are supported by several cost-utility analyses.

Medical Research: What are the main findings?

Dr. Sheikh:  The main findings of the study are:

  • The cost of hospitalization is three times higher for patients with
    atrial fibrillation than those without atrial fibrillation.
  • 5 million new cases are being reported annually.
  • The incidence of atrial fibrillation is projected to increase from
    1.2 million cases in 2010 to 2.6 million cases by 2030. Due to this
    increase in incidence, the prevalence of atrial fibrillation is
    projected to increase from 5.2 million cases to 12.1 million cases by
    2030.
  • The most common co-moribidites associated with atrial fibrillation
    were hypertension, diabetes mellitus, and chronic obstructive lung
    disease.
  • According to the NIS database, the atrial fibrillation.
    hospitalization rate has increased from 1552 to 1812 per one million
    US residents per year from 2000 to 2010 (relative increase 14.4%).
  • According to the NIS database, the mortality associated with atrial
    fibrillation hospitalizations has decreased significantly from 1.2% in
    2000 to 0.9% in 2010 (relative decrease 29.2%).
  • The median length of stay in the hospital is 3 days and increases
    proportionally with a rise in CHADS2 score.
  • The largest source of direct healthcare costs associated with
    atrial fibrillation is hospitalization. According to the NIS database,
    the mean cost of inpatient atrial fibrillation hospitalization
    increased significantly from $6401 in 2001 to $8439 in 2010 (relative
    increase 24.0%). The mean cost of atrial fibrillation hospitalization
    also increases proportionally with a rise in CHADS2 score.
  • In the outpatient setting, the highest costs were associated with
    physician office visits in comparison to emergency room and urgent
    care visits.
  • With regards to prevention of thromboembolism, the new oral
    anticoagulant agents (dabigatran, rivaroxaban, and apixaban) have been
    found to be more cost-effective compared to warfarin.
  • Left atrial catheter ablation is more effective than rate control
    and rhythm control. It is more cost-effective in younger patients who
    are moderate risk for stroke.

Medical Research: What should clinicians and patients take away from your report?

Dr. Sheikh: Clinicians should pay strong attention to the risk factors associated
with atrial fibrillation. Their practice should emphasize on
preventing and limiting the progression of risk factors attributed to
the development of atrial fibrillation. Once the patients have
developed atrial fibrillation, the clinician should consider the use
of new oral anticoagulant agents over warfarin unless a
contradindication exists limiting their use. They should also consider
early referral to a cardiac electrophysiologist for ablation in a
younger patient population who are at moderate risk for stroke. Those
who are not candidates for ablation should be managed using the rate
control strategy.

Patients also need to emphasize their attention towards the reversible
risk factors associated with atrial fibrillation. They should have
frequent follow up with their primary doctors to optimally manage each
condition associated with atrial fibrillation.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Sheikh: In the future, additional cost-utility analyses are required for

  • comparing each of the new oral anticoagulants amongst each other.
  • comparing cryoballoon ablation to radiofrequency ablation.
  • comparing each device used for left atrial appendage closure amongst each other.

Citation:

Trends in Hospitalization for Atrial Fibrillation : Epidemiology, Cost, and Implications for the Future

Sheikh, Azfar et al.
Progress in Cardiovascular Diseases

 

Azfar B. Sheikh, M.D. (2015). Atrial Fibrillation Increase Leading To More Hospitalizations and Higher Costs MedicalResearch.com