Atrial Fibrillation and Managed Care: Current Approaches and Future Directions for Long-Term Therapy

Abstract

BACKGROUND: Atrial fibrillation (AF) is a common, age-related arrhythmia that disproportionately affects men, adversely affects quality of life, and causes considerable morbidity and mortality. OBJECTIVES: To describe trends in the prevalence and incidence of AF in the United States; discuss the etiologies and complications of AF; characterize the economic burden of AF; and predict an individual’s risk for developing AF and AF-related stroke. SUMMARY: The prevalence and incidence of AF in the United States are expected to increase in the coming decades because of the aging of the population; improved survival rates associated with coronary heart disease, heart failure, and hypertension; and increased rate of performance of surgical procedures. The economic burden of AF is substantial because of high rates of hospitalization and other health resource utilization. Hypertension, coronary heart disease, and systolic heart failure are the most important risk factors for AF. Ischemic stroke is the most devastating complication of AF. Risk factors for stroke in patients with AF include recent congestive heart failure, hypertension, advanced age, diabetes mellitus, and a history of stroke or transient ischemic attack. Risk scoring systems have been developed to predict an individual’s risk for developing AF and the risk for stroke in a patient with AF. The estimated lifetime risk for AF in men and women aged 40 years of age or older is 1 in 4, which is higher than the risk for other diseases that are a common cause for concern among elderly patients. CONCLUSIONS: The clinical and economic burden of AF in the United States is large and will continue to increase in the future. The use of scoring systems to predict the risk of AF and AF-related stroke affords clinicians the opportunity to intervene to minimize these risks and improve patient outcomes. J Manag Care Pharm. 2009;15(6-b)(Suppl):S4-S9 Copyright © 2009, Academy of Managed Care Pharmacy. All rights reserved. CYNTHIA A. SANOSKI, PharmD, FCCP, BCPS, is Associate Professor and Chair, Department of Pharmacy Practice, Jefferson School of Pharmacy, Thomas Jefferson University, Philadelphia, Pennsylvania. AUTHOR CORRESPONDENCE: Cynthia A. Sanoski, PharmD, FCCP, BCPS, Chair, Department of Pharmacy Practice, Jefferson School of Pharmacy, Thomas Jefferson University, 130 9th St., Ste. 1540, Philadelphia, PA 19107-5233. Tel.: 215.503.1722; Fax: 215.503.9052; E-mail: cynthia.sanoski@jefferson.edu Author Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting approximately 2.2 million Americans.1 The prevalence of AF increases with age, with 70% of cases occurring in patients between the ages of 65 years and 85 years (Figure 1).2 Atrial fibrillation is also more common in men than in women at all ages. For example, a cohort of 2,090 men and 2,641 women who participated in the Framingham Heart Study and did not have AF at the time of enrollment were followed for 38 years.3 After adjusting for age and other AF risk factors, the men were 50% more likely to develop AF than were the women. The higher risk of AF in men persisted in each decade between 55 and 94 years of age (Figure 2).