Dramatic Increase In Hospitalizations For Atrial Fibrillation As Population Ages

MedicalResearch.com Interview with:
Nileshkumar J. Patel MD
Staten Island University Hospital
Staten Island, NY, 10304 and
Abhishek J. Deshmukh MD
University of Arkansas
Little Rock, AR

MedicalResearch: What are the main findings of the study?

Answer: We analyzed data from almost 4 million hospitalizations for atrial fibrillation (AF) from more than 1,200 hospitals across 45 states in last decade, and found that

–   Hospitalization rates for atrial fibrillation have increased exponentially among US adults during the past 10 years, particularly in those 65 years or older.

–   The most frequent coexisting conditions were hypertension (59.99%), diabetes (21.47%) and chronic pulmonary disease (20.01%).

–   In terms of geographic distribution of admissions, the hospitals in the South constitute (38.5%) the highest percentage of atrial fibrillation hospitalizations, followed by Midwest (24.9%), Northeast (22.2%) and West (14.4%).

–   Overall in-hospital mortality was 1%. The mortality rate was highest in >80 years age group (1.93%) and patients with concomitant heart failure (8.2%).

–   The percentage of patients discharged to nursing facility increased from 8.1% in 2000 to 11.5% in 2010 and need for home health care increased from 6.7% to 13.1%. Approximately one fourth of the patients (25.83%) were discharged to long-term care institution if atrial fibrillation hospitalization was complicated by acute ischemic stroke.

–   Mean cost of AF hospitalization increased significantly from $6,410 in 2001 to $8,439 in 2010 (24.04% increase, p <0.001) even after adjusting for inflation. This represents an absolute increment in annual national cost from approximate 2.15 billion dollars in 2001 to 3.46 billion dollars in 2010. The mean cost of care was highest if AF hospitalization was associated with heart failure ($33,161) and valvular disorders ($28,030).

MedicalResearch: Were any of the findings unexpected?

Answer: No. Our findings are well correlate to what we experience in day to day life but the most worrisome problem is an exponential increase in the number of hospitalization in 80 years or older patient population. Patients 80 years or older comprised the maximum number of admissions per million US population for any age group throughout the study. This age group had an exponential increase in the number of hospitalization from 9361per million population per year in 2000 to 11045 per million population per year in 2010. This is alarming as the number of persons aged >80 years is expected to increase from 11.4 million in 2008 and to 19.5 million in 2030; which in turn will lead to an enormous increased burden on the public health system and medical services. In addition, we found that the mortality in this age group was considerably higher than in the rest of the population. The increasing number of AF hospitalizations together with the higher in-hospital mortality in this age group, highlights that there is an urgent need to take preventive and quality improvement steps as we did for heart failure.

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

Answer: The hike in AF hospitalizations is probably because we’re living longer and accompanying risk factors such as high blood pressure, obesity, sleep apnea and diabetes are increasing. Seniors over 65 are the fastest growing age group in the United States. Mortality and morbidity associated with atrial fibrillation in this age group suggests atrial fibrillation will become a major burden on hospitals. The economic burden associated with AF is growing considerably and is driven primarily by the rising cost of hospitalizations. We must treat atrial fibrillation and its risk factors better in the outpatient setting to prevent hospitalizations and reduce its staggering impact.

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

Answer: Atrial fibrillation is a disease in itself, but it also serves as a marker for the severity of other illnesses. The economic burden associated with AF is growing considerably and is driven primarily by the rising cost of hospitalizations. We must treat atrial fibrillation and its risk factors better in the outpatient setting to prevent hospitalizations and reduce its staggering impact. Future efforts to reduce this economic burden must be focused on limiting hospitalizations and length of stay. Certain interventions such as emergency room observation units vs. hospital admission, rate control vs. rhythm control and use of low molecular weight heparin vs. unfractionated heparin have been previously described as potential measures to reduce the cost associated with the treatment of AF.

Citation:

Trends of Hospitalization for Atrial Fibrillation in the United States, 2000
Through 2010: Implications for Healthcare Planning

Nileshkumar J. Patel, Abhishek Deshmukh, Sadip Pant, Vikas Singh, Nilay Patel, Shilpkumar Arora, Neeraj Shah, Ankit Chothani, Ghanshyambhai T. Savani, Kathan Mehta, Valay Parikh, Rathod, Apurva O. Badheka, James Lafferty, Marcin Kowalski, Jawahar L. Mehta, Raul D. Mitrani, Juan F. Viles-Gonzalez, and Hakan Paydak

Circulation. 2014;CIRCULATIONAHA.114.008201published online before print May 19 2014, doi:10.1161/CIRCULATIONAHA.114.008201

 

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