Treating atrial fibrillation patients costs U.S. $26 billion annually

Study Highlights:

• Patients with atrial fibrillation (AF) added $26 billion to the nation’s healthcare costs in one year: $6 billion for AF care; $9.9 billion for other cardiovascular risk factors or disease and $10.1 billion for non-cardiovascular health problems according to recently published research.
• AF patients were hospitalized twice as often, had three times the rate of multiple hospitalizations, and had four times as many cardiovascular admissions as patients without the condition.

DALLAS, May 3, 2011 — Treating patients with atrial fibrillation (AF) costs the United States an estimated $26 billion more per year than treating patients without AF, according to research reported in Circulation: Cardiovascular Quality and Outcomes, a journal of the American Heart Association.

“Atrial fibrillation places a huge economic burden on healthcare payers, patients and our country,” said Michael H. Kim, M.D., lead author of the study and associate professor of medicine at Northwestern University in Chicago. “It is not clear that the country realizes that atrial fibrillation patients are much more likely to have cardiovascular hospitalizations specifically, and more hospitalizations in general.”

The estimated $26 billion annual cost consisted of $6 billion (23 percent) related to AF, $9.9 billion for cardiovascular risk factors or disease and $10.1 billion for non-cardiovascular medical problems.

AF is an irregular heart rhythm that occurs when the heart’s upper chambers beat erratically, causing the chambers to pump blood inefficiently. Blood can pool and clot in the chambers, increasing the risk of stroke or heart attack. AF affects three million American adults, a number expected to double over the next 25 years.

Researchers selected 89,066 AF patients using two medical records databases that totaled 38 million people. Seventy-five percent of the AF patients were covered by Medicare.

Researchers matched AF patients by gender, age and other medical problems (such as high blood pressure or structural heart disease) with a control group of patients without AF. They followed each pair of patients for 12 months during 2004-2006, starting with AF hospitalization.

Among the study’s significant findings:

• AF patients entered the hospital for any reason twice as often as non-AF patients (37.5 percent versus 17.5 percent), and were three times more likely to have multiple hospitalizations (11.1 percent versus 3.3 percent).
• AF patients were hospitalized for cardiovascular problems four times more than non-AF patients (21.3 percent versus 5.4 percent), and had multiple cardiovascular hospital admissions eight times more often (4.1 percent versus 0.5 percent).
• More AF patients than non-AF patients died in the hospital (2.1 percent versus 0.1 percent).
• Total direct healthcare costs averaged $20,670 for the AF group and $11,965 for the non-AF group, a difference of $8,705 due mostly to inpatient services.
• Among AF patients studied, 19.5 percent were newly diagnosed and 80.5 percent had existing AF.

“We’re not going to impact healthcare costs or cardiovascular outcomes by just addressing atrial fibrillation itself,” Kim said. “The large amount of cardiovascular disease among atrial fibrillation patients appears to worsen outcomes and increase costs. This is a sicker population.”

Previous studies assessing the cost of AF are difficult to apply nationally and may be outdated due to recent changes in how the disorder is managed. Small sample sizes or those limited to young AF patients don’t accurately reflect the nation’s total AF population, researchers said. More than 460,000 new cases of AF are diagnosed per year, and the disorder contributes to more than 80,000 deaths annually.

“Atrial fibrillation is a significant issue and it is clearly causing primary hospitalizations, but we are likely underestimating its costs,” Kim said.

Co-authors are Stephen S. Johnston, M.A.; Bong-Chul Chu, Ph.D.; Mehul R. Dalal, Ph.D.; and Kathy L. Schulman, M.S. Author disclosures are on the manuscript.

Sanofi-Aventis US, Inc. funded the study.

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NR11 – 1073(Circ. Quality & Outcomes/Kim)

 Additional resources:

• Learn more about atrial fibrillation at www.heart.org/afib.
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