Economic Burden Of Atrial Fibrillation Research Articles

Development of a Care Pathway for Atrial Fibrillation Patients in the Emergency Department.

Atrial fibrillation (AF) is the most common cardiac arrhythmia and its prevalence is continuously increasing in the United States, leading to a progressive rise in the number of disease-related emergency department (ED) visits and hospitalizations. Although optimal long-term outpatient management for AF is well defined, the guidelines for optimal ED management of acute AF episodes is less clear. Studies have demonstrated that discharging patients with AF from the ED after acute stabilization is both safe and cost effective; however, the majority of these patients in the United States and in our institution are admitted to the hospital. To improve care of these patients, we established a multidisciplinary collaboration to develop an evidence-based systematic approach for the treatment and management of AF in the ED, that led to the creation of the University of California-Cardioversion, Anticoagulation, Rate Control, Expedited Follow-up/Education Atrial Fibrillation Pathway. Our pathway focuses on the acute stabilization of AF, adherence to best practices for anticoagulation, and reduction in unnecessary admissions through discharge from the ED with expedited outpatient follow-up whenever safe. A novel aspect of our pathway is that it is primarily driven by the ED physicians, while other published protocols primarily involve consulting cardiologists to guide management in the ED. Our protocol is very pertinent considering the current trend toward increased AF prevalence in the United States, coupled with a need for widespread implementation of strategies aimed at improving management of these patients while safely reducing hospital admissions and the economic burden of AF.

Genetics of atrial fibrillation-practical applications for clinical management: if not now, when and how?

The prevalence and economic burden of atrial fibrillation (AF) are predicted to more than double over the next few decades. In addition to anticoagulation and treatment of concomitant cardiovascular conditions, early and standardized rhythm control therapy reduces cardiovascular outcomes as compared with a rate control approach, favouring the restoration, and maintenance of sinus rhythm safely. Current therapies for rhythm control of AF include antiarrhythmic drugs (AADs) and catheter ablation (CA). However, response in an individual patient is highly variable with some remaining free of AF for long periods on antiarrhythmic therapy, while others require repeat AF ablation within weeks. The limited success of rhythm control therapy for AF is in part related to incomplete understanding of the pathophysiological mechanisms and our inability to predict responses in individual patients. Thus, a major knowledge gap is predicting which patients with AF are likely to respond to rhythm control approach. Over the last decade, tremendous progress has been made in defining the genetic architecture of AF with the identification of rare mutations in cardiac ion channels, signalling molecules, and myocardial structural proteins associated with familial (early-onset) AF. Conversely, genome-wide association studies have identified common variants at over 100 genetic loci and the development of polygenic risk scores has identified high-risk individuals. Although retrospective studies suggest that response to AADs and CA is modulated in part by common genetic variation, the development of a comprehensive clinical and genetic risk score may enable the translation of genetic data to the bedside care of AF patients. Given the economic impact of the AF epidemic, even small changes in therapeutic efficacy may lead to substantial improvements for patients and health care systems.

Major bleed costs of atrial fibrillation patients treated with factor Xa inhibitor anticoagulants

Objective To examine the healthcare economic burden of atrial fibrillation (AF) patients treated with factor Xa inhibitor (FXaI) anticoagulants who were hospitalized in the US with a major bleed (MB) Methods Adult AF patients treated with FXaIs and hospitalized with an MB were selected from MarketScan databases (1 January 2015–30 April 2018). Patients were grouped into cohorts based on type of MB: intracranial hemorrhage (ICH), gastrointestinal (GI), other types of MB. Healthcare costs in 2019 USD were evaluated for index hospitalizations and during a variable follow-up period in unadjusted and adjusted analyses. Results Of the overall AF patient population treated with FXaIs and hospitalized with an MB (n = 7,577), 9.9% had ICH (mean age: 77.9 years; 58% male), 55.9% had GI (mean age: 76.8 years; 52% male), and 34.2% had other types of MB (mean age: 74.4 years; 61% male). Mean index hospitalization costs for ICH, GI, and other type of MB were $54,163, $26,901, and $36,645, respectively; from adjusted analyses, patients with ICH vs. GI spent 1.6 more days in the hospital; mean cost was $15,630 higher. Patients with other types of MB vs. GI spent 0.6 more days in the hospital; mean cost was $5,859 higher. Index hospitalization cost in addition to total all-cause healthcare costs incurred in the follow-up period were $34,522 higher per ICH patient and $11,584 higher per other type of MB patient vs. a GI MB patient. Limitations Since this study was a retrospective observational study using a claims database analysis, a causal relationship between treatment with FXaIs and MB events cannot be established. Conclusions Although all of the evaluated MB types were associated with high hospitalization costs, ICH was associated with the most substantial short- and long-term healthcare economic burden.

A Review of the Burden of Atrial Fibrillation: Understanding the Impact of the New Millennium Epidemic across Europe

Atrial fibrillation (AF), the most common form of arrhythmia, is fast becoming one of the world’s most significant health issues. It is well established that AF increases the risk of mortality, and is associated with significant morbidity, including an increased risk of stroke. AF also worsens quality of life for patients, which can also be a burden for caregivers. As a result of Europe’s ageing population, the prevalence of AF is expected to rise substantially in the future. With more patients expected to be affected by AF, rates for AF-related strokes, hospitalisations, and doctor visits are also expected to rise, ultimately raising healthcare system costs across Europe. It is estimated that up to 2.6% of total annual healthcare expenditure is associated with AF in European countries. The high cost of AF is largely attributable to hospitalisations and complications such as stroke, i.e., in 2015, stroke was estimated to cost €45 billion a year in the European Union (EU). The purpose of this review is to highlight the current scale and growing burden of this new millennium epidemic in Europe. This review aims to foster a greater awareness and understanding of the magnitude of the clinical, patient, and economic burden of AF. An understanding of the burden of AF is imperative for directing care pathway management and healthcare policies that can help alleviate the burden of AF experienced by patients, caregivers, and healthcare systems in Europe.

PMD15 - Economic Burden of Atrial Fibrillation in Japan

The burden of AF including stroke related costs is considered to remain substantial. The objective of this study is to assess the annual health care cost of AF in Japan. A systematic literature review was conducted through searching MEDLINE and Ichushi-Web to identify evidence used in the analysis. We estimated the total number of patients with AF in Japan based on the prevalence rate of AF and the size of Japanese population. Total costs included treatment costs of major events associated with AF (stroke and bleedings), AF treatment costs and post-event long-term care costs. AF patients are assumed to be treated with warfarin, DOACs, or no treatment. Annual drug costs and outpatient costs were included and dosage of each drugs were correlated to relevant observational studies. The incidence rates of ischemic stroke (IS), hemorrhagic stroke (HS), intracranial hemorrhage (ICH) and gastrointestinal bleeding and average cost of each event were retrieved from the literature. Treatment costs of stroke and ICH were estimated by severity of disability. Annual number of IS, HS, ICH and gastrointestinal bleeding was estimated to be approximately 23,000, 8,500, 9,400 and 14,000, respectively. The annual medical cost and long-term care cost per patient was estimated to be JPY 104,000 - 145,000. The number of AF patients in Japan was 1.32 million in 2017, therefore, the nation-wide annual medical cost and long-term care cost of AF was estimated to be approximately JPY 137.5 billion - 191.4 billion over this period. The annual medical cost and long-term care cost of AF in Japan was high. As the prevalence of AF tends to be higher in the elderly population, the incidence of AF will further increase making the impact of the burden more enormous in Japan due to a large proportion of the population entering old age.

PCV58 - The Economic Burden of Atrial Fibrillation in Latin America

The economic burden of atrial fibrillation (AF) in the Latin American region has not been previously quantified. This research assessed the economic burden of AF in Brazil, Chile, Colombia, Ecuador, El Salvador, Mexico, Panama, Peru, Venezuela. To estimate the cost of AF by country, a prevalence approach was used. Costs were estimated for the year 2015 and included health system expenditures, productivity losses (absenteeism, lower workforce participation, premature mortality) and informal care costs, and deadweight losses associated with government expenditures. Data inputs for costs, including prevalence and mortality were based on secondary data sources informed by a targeted literature review including country specific grey literature and data sources. The study also appraised the value of the loss of healthy life, measured in disability adjusted life years (DALYs), using global burden of disease disability weights. AF was found to affect approximately 2.7 million people (0.8% of the adult population, average of 69.5 years old) in selected Latin American countries in 2015. This leads to significant wellbeing loss, estimated at 664,460 DALYs, and economic burden, estimated at USD2.4 billion in 2015. Health system expenditures accounted for USD2.3billion (95%) and productivity costs USD115million (5%) of the total financial burden of AF. On average, health system expenditure represented 0.06% of total gross domestic product (GDP) across the nine countries with Brazil (0.07%), Chile (0.08%), Colombia (0.07%), Ecuador (0.06%) and El Salvador (0.13%) spending more than the average. Total financial costs averaged 0.06% of GDP. AF imposes a significant burden to the health system and society in Latin America. Health system expenditure accounts for the majority of the burden of AF in the region. Prevention and appropriate management of AF may result in substantial wellbeing benefits and economic savings.

PCV57 - The economic burden of atrial fibrillation -related stroke in China

PCV57 - The economic burden of atrial fibrillation -related stroke in China

PHS3 - Clinical and economic burden of atrial fibrillation in medicare beneficiaries with acute coronary syndrome

PHS3 - Clinical and economic burden of atrial fibrillation in medicare beneficiaries with acute coronary syndrome

PMD39 The Economic Burden of Atrial Fibrillation among Elderly Populations in Selected Developed Countries

PMD39 The Economic Burden of Atrial Fibrillation among Elderly Populations in Selected Developed Countries

PMD37 Forecasting the Prevalence and Economic Burden of Atrial Fibrillation in Selected Countries, 2010-2025

PMD37 Forecasting the Prevalence and Economic Burden of Atrial Fibrillation in Selected Countries, 2010-2025

PMD14 Estimating the Economic Burden of Atrial Fibrillation in Selected Developing Countries

PMD14 Estimating the Economic Burden of Atrial Fibrillation in Selected Developing Countries

PMD16 Forecasting the Prevalence and Economic Burden of Atrial Fibrillation in Selected Countries, 2010 - 2025

PMD16 Forecasting the Prevalence and Economic Burden of Atrial Fibrillation in Selected Countries, 2010 - 2025

PMD15 The Economic Burden of Atrial Fibrillation among Elderly Populations in Selected Developed Countries

PMD15 The Economic Burden of Atrial Fibrillation among Elderly Populations in Selected Developed Countries

Clinical, economic, and quality of life impact of atrial fibrillation.

Atrial fibrillation (AF) is a common, age-related arrhythmia that disproportionately affects men, adversely affects quality of life, and causes considerable morbidity and mortality. 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. 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. 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.

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

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).

Treatment of atrial fibrillation

Atrial fibrillation (AF) is the most common arrhythmia and is associated with substantial morbidity, including heart failure and stroke.w1 AF is often encountered in patients with underlying heart disease such...