Abstract
Atrial fibrillation imposes a significant economic burden on healthcare in the USA. The incidence and prevalence of this condition are growing, especially in the elderly population. Currently at least 3 million people are diagnosed with atrial fibrillation in the USA, and the prevalence is expected to exponentially increase over the ensuing decades. Hospital admissions for atrial fibrillation reached 479,000 in 2010. The costs to the healthcare system result not only from direct costs of care related to the arrhythmia itself but also to the associated complications of the disease, its treatment, and comorbid conditions, as well as societal costs of lost productivity. Total incremental costs for atrial fibrillation in the USA are estimated to range from $6 to $26 billion annually. The management of atrial fibrillation has evolved over the last decade to include new antiarrhythmic agents, novel anticoagulants, and more invasive treatment options which contribute to the increasing costs of care. New strategies that utilize cost-effective treatment approaches in atrial fibrillation are required to help reduce the total economic burden of this condition. A shift to outpatient treatment options can impact overall costs of care in a positive manner. The use of observation status or dedicated atrial fibrillation clinics may help to reduce inpatient admissions and reduce overall costs of care. New models for inpatient care that merge quality and cost initiatives can enhance clinical outcomes and reduce hospital-related costs.
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References
Mozaffarian D, et al. Heart disease and stroke statistics – 2015 update. A Report from the American Heart Association. Circulation. 2015;131:e219.
Naccarelli GV, Varker H, Lin J, Schulman KL. Increasing prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol. 2009;104:1534–9.
Go AS, Hylek EM, Phillips K, et al. Prevalence of diagnosed atrial fibrillation in adults: National implications for rhythm management and stroke prevention: the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285:2370.
Colilla S, Crow A, Petkun W, et al. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am J Cardiol. 2013;112:1142–7.
Knight PB, et al. Practical management of atrial fibrillation. Updated July 2014. Heart Rhythm Society. www.HRSonline.org
Miyasake Y, et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000 and implications on the projections for future prevalence. Circulation. 2006;114:119–25.
Alonso A, Agarwal SK, Soliman EZ, et al. Incidence of atrial fibrillation in whites and African Americans: the Atherosclerosis Risk in Communities (ARIC) study. Am Heart J. 2009;158:111–7.
Piccini JP, Hammill BG, Sinner MF, et al. Incidence and prevalence of atrial fibrillation and associated mortality among Medicare beneficiaries, 1993–2007. Circ Cardiovasc Qual Outcomes. 2012;5:85–93.
Lee WC, Lamas GA, Balu S, et al. Direct treatment cost of atrial fibrillation in the elderly American population: a Medicare perspective. J Med Econ. 2008;11:281–98.
Coyne KS, Paramore C, Grandy S, et al. Assessing the direct costs of treating non-valvular atrial fibrillation in the United States. Value Health. 2006;9:348–56.
LaPar DJ, Spier AM, Crosby IK, et al. Postoperative atrial fibrillation significantly increases mortality, hospital readmission, and hospital costs. Ann Thoracic Surg. 2014;98:527–33.
Steinberg BA, Kim S, Fonarow GC, et al. Drivers of hospitalization for patients with atrial fibrillation: results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). Am Heart J. 2014;167:735–42.
Mulcahy B, Coates WC, Hennerman PL, et al. New-onset atrial fibrillation: when is admission medically justified? Acad Emerg Med. 1996;3:114–9.
Kim MH, Johnston SS, Chu BC, et al. Estimation of total incremental health care costs in patients with atrial fibrillation in the United States. Circ Cardiovasc Qual Outcomes. 2011;4:313–20.
Reynolds MR, Essebag V. Economic burden of atrial fibrillation: implications for intervention. www.ajmc.com/print.php?url=/journals/ajpb/2012/AJPB_MarApr2012/Economic-Burden-of-Atrial-Fibrillaiton-Implications-for-Intervention. Accessed 19 May 2015.
McDonald AJ, Pelletier AJ, Ellinor PT, et al. Increasing US emergency department visit rates and subsequent hospital admissions for atrial fibrillation from 1993 to 2004. Ann Emerg Med. 2008;51:58–65.
Zimetbaum P, Reynolds MR, Ho KK, et al. Impact of a practice guideline for patients with atrial fibrillation on medical resource utilization and costs. Am J Cardiol. 2003;92:677–81.
Khairallah F, Ezzedine R, Ganz LI, et al. Epidemiology and determinants of outcomes of admissions for atrial fibrillation in the United State from 1996- to 2001. Am J Cardiol. 2004;94:500–4.
Heart Disease and Stroke Statistics –2009 Update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009;119:e21–181
Wu EQ, Birnbaum HG, Mareva M, et al. Economic burden and co-morbidities of atrial fibrillation in a privately insured population. Curr Med Res Opin. 2005;21(10):1693–9.
Patel NJ, Deshmukh A, Pant S, et al. Contemporary trends of hospitalization for atrial fibrillation in the United States, 2000 through 2010: implications for healthcare planning. Circulation. 2014;129:2371–9.
Rohrbacker NJ, Kleinman NL, White SA, et al. The burden of atrial fibrillation and other cardiac arrhythmias in an employed population: associated costs, absences, and objective productivity loss. J Occup Environ Med. 2010;52(4):383–91.
Ringborg A, Nieuwlaat R, Lindgren P, et al. Costs of atrial fibrillation in five European countries: results from the Euro Heart Survey on atrial fibrillation. Europace. 2008;10(4):403–11.
Marshall DA, Levy AR, Vidaillet H, et al. AFFIRM and CORE Investigators. Cost-effectiveness of rhythm versus rate control in atrial fibrillation. Ann Intern Med. 2004;141(9):653–61.
Reynolds MR, Essebag V, Zimetbaum P, et al. Healthcare resource utilization and costs associated with recurrent episodes of atrial fibrillation: the FRACTAL registry. J Cardiovasc Electrophysiol. 2007;18(6):628–33.
Kim MH, Klingman D, Lin J, et al. Cost of hospital admission for antiarrhythmic drug initiation in atrial fibrillation. Ann Pharmacother. 2009;43(5):840–8.
Khaykin Y, Morillo CA, Skanes AC, et al. Cost comparison of catheter ablation and medical therapy in atrial fibrillation. J Cardiovasc Electrophysiol. 2007;18(9):907–13.
Bussey HI, Rospond RM, Quandt CM, Clark GM. The safety and effectiveness of long-term warfarin therapy in an anticoagulation clinic. Pharmacotherapy. 1989;9(4):214–9.
Bussey HI, Chiquette E, Amato MG. Anticoagulation clinic care versus routine medical care: a review and interim report. J Thromb Thrombolysis. 1996;2:315–9.
Chiquette E, Amato MG, Bussey HI. Anticoagulation control, patient outcomes, and health care costs. Arch Intern Med. 1998;158(15):1641–7.
Chiquette E, Amato MG, Bussey HI. Comparison of an anticoagulation clinic with usual medical care: anticoagulation control, patient outcomes, and health care costs. Arch Intern Med. 1998;158(15):1641–7.
Sullivan PW, Arant TW, Ellis SL, et al. The cost effectiveness of anticoagulation management services for patients with atrial fibrillation and at high risk of stroke in the US. Pharmacoeconomics. 2006;24(10):1021–33.
Hendriks J, et al. Specialized atrial fibrillation clinic reduces cardiovascular morbidity and mortality in patients with atrial fibrillation. Amer Coll Cardiol. 2011; Abstract 3016–12.
Hendriks J, Tomini F, van Asselt T, et al. Cost-effectiveness of a specialized atrial fibrillation clinic vs usual care in patients with atrial fibrillation. Europace. 2013;15:1128–35.
http://my.clevelandclinic.org/services/heart/departments-centers/atrial-fibrillation.
Spectrum Health’s atrial fibrillation ED clinical pathway and AF Clinic. EP Lab Digest. 2013;13(9).
McKesson. Level of care. Acute Adult Arrhythmia. InterQual® 2014.
Medicare Benefit Policy Manuel, CMS Pub. 100-02,Ch 6, 20.6.
Medicare Program Integrity Manual Chapter 3 – Verifying Potential Errors and Taking Corrective Actions.
Medicare Claims Processing Manual. Chapter 4 – Part B Hospital (Including Inpatient Hospital Part B and OPPS). Table of Contents (Rev. 3181, 01-30-15) (Rev. 3280, 06-05-15). 10.2.1 – Composite APCs. (Rev. 2903, Issued: 03-11-14, Effective: 04-01-14, Implementation: 04-07-14).
Medicare Payment Advisory Commission. 2015. Report to the Congress: Medicare and the health care delivery system. Washington, DC: MedPAC.
Ross, MA, Wilson AG, McPherson M. The impact of an ED observation unit bed on inpatient bed availability. Acad Emerg Med. 2001;8:576
Coffey RM†, Barrett ML†, Steiner S‡. Final Report Observation Status Related to Hospital Records. 2002. HCUP Methods Series Report #2002–3. ONLINE September 27, 2002. Agency for Healthcare Research and Quality. Available: http://www.hcup-us.ahrq.gov
Peacock WF, Remer EE, Aponte J, et al. Effective observation unit treatment of decompensated heart failure. Congest Heart Fail. 2002;8:68–73.
Baugh CW, Venkatesh AK, Bohan JS. Health Care Management Review. March 2011;36(1):28–37
Baugh CW, Venkatesh AK. Making Greater Use Of Dedicated Hospital Observation Units For Many Short-Stay Patients Could Save $3.1 Billion A Year. Health Affair September 2012.
Nahab F, Leach G, Kingston C, et al. Impact of an emergency department observation unit transient ischemic attack protocol on length of stay and cost. J Stroke Cerebrovasc Dis. 2012;21:673–8.
Ross MA, Hockenberry JM, Mutter R, et al. Protocol-driven emergency department observation units offer savings, shorter stays, and reduced admissions. Health Aff. 2013;32(12):2149–56.
Decker WW, Smars PA, Vaidyanathan L, et al. A prospective, randomized trial of an emergency department observation unit for acute onset atrial fibrillation. Ann Emerg Med. 2008;52:3232–328.
Sieck S. Cost-effectiveness of chest pain units. Cardiol Clin. 2005;23(4):589–99. ix.
Sieck S. Short stay management of chest pain. HumanaPress; 2009. Ch 2, p. 15–35.
Sieck S. Cost effectiveness of chest pain units. Cardiol Clin. 2005;23(4):598.
Sieck S. Sieck Healthcare. Cost effectiveness of chest pain units. Cardiol Clin. 2005;23(4):597.
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Sieck, S. (2016). The Economic Impact of Atrial Fibrillation in the US. In: Peacock, W., Clark, C. (eds) Short Stay Management of Atrial Fibrillation. Contemporary Cardiology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-31386-3_3
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