Association between atrial fibrillation and healthcare costs among patients with cardiac implantable electronic devices

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Previous research on atrial fibrillation (AF)-related healthcare cost is limited by claims-derived categorization of AF diagnosis and does not assess for incremental differences in cost based on degree of AF burden. Objective To directly assess the incremental cost of device detected AF (ddAF), and compare relative costs among cohorts with no AF, paroxysmal AF (pAF), persistent AF (PeAF), and permanent AF (PermAF) in patients with cardiac implantable electronic devices (CIED) capable of sensitive and continuous atrial arrhythmia detection. Methods Using the de-identified Optum® Clinformatics® U.S. claims database (2015 to 2020) linked with the Medtronic CareLink® database, we identified CIED patients that transmitted data ≥6 months post-implant (baseline period). Annualized per-patient costs in follow up were analyzed from insurance claims and adjusted to 2020 US Dollars. Total costs were compared between patients with no AF and those with device detected pAF, PeAF and PermAF. Analyses were adjusted for geographical region, insurance type, CHA2DS2-VASc Score, and implant year. Results Of the 21,391 patients (72.9±10.9 yrs; 56.3% male) analyzed, 7,798 (36.5%) had ddAF. Among these, 5,966 (76.5%) were pAF (avg burden 2.9±8.6%), 1,145 (14.7%) were PeAF (avg burden 47.2±29.9%), and 687 (8.8%) were PermAF (avg burden 99.3±0.7%). Patients with ddAF had higher overall annualized total healthcare costs than those without ddAF (fig). The incremental annualized increased cost in those with ddAF was $12,789 ± $161,749 per patient. Patients with pAF, PeAF and PermAF all had higher adjusted healthcare costs than those without AF (p for all <0.001). Patients with PeAF and PermAF both had higher total adjusted costs than patients with pAF. In addition, patients with PeAF had higher healthcare costs than those with PermAF (fig). Conclusions In the present analysis of CIED patients, ddAF was associated with increased healthcare costs after adjustment for clinical and demographic covariates. Among those with ddAF, patients with PeAF had the highest healthcare costs. Preventing development of AF, and progression to PeAF, may reduce healthcare costs.