CardioExchange Archive

In recent years there has been an explosion of interest in atrial fibrillation (AF). Now a new study published in Circulation finds that hospitalizations for AF are on the increase, and this may have important implications for the delivery and economics of health care in the coming years.

Researchers analyzed data  from nearly 4,000,000 hospitalizations in which AF was the primary discharge diagnosis from the years 2000 through 2010. Here are some of their key findings:

About two-thirds of the patients were white and over the age of 65.

Over the course of a decade the AF hospitalization rate increased by 14.4% (p<0.001), from 1552 to 1812 per million people per year.

The mean age of patients was 66 years for men and 74 for women.

A total of 66% of AF patients under age 65 were male. In sharp contrast, 61% of AF patients over age 65 were female.

Overall hospital mortality for AF was 1%. Mortality declined from 1.2% at the start of the study to 0.9% at the end (p<0.001).

There was a huge increase in the number of patients over the age of 80, with the rate increasing from 9,361 to 11,045 per million population per year, and these patients had a significantly higher in-hospital mortality rate. The authors discussed the significance of the growing elderly AF population: “These figures are alarming as the number of persons aged >80 years is expected to increase from 11.4 million in 2008 to 19.5 million in 2030; which in turn will lead to an enormous increased burden on the public health system and associated cost of care.”

Median length of stay was three days throughout the study, but the cost of the hospitalization increased from $6,410 to $8,439, resulting in an overall increase in annual national cost from $2.15 billion to $3.46 billion.

The authors reflected on the “economic burden” of AF in the future:

Future efforts to reduce this economic burden must be focused on limiting hospitalizations and length of stay. Certain interventions such as emergency room observation units vs. hospital admission, rate control vs. rhythm control and use of low molecular weight heparin vs. unfractionated heparin have been previously described as potential means to reduce the cost associated with the treatment of AF.

“Atrial fibrillation is a disease in itself, but it also serves as a marker for the severity of other illnesses,” said Nileshkumar Patel, lead author of the study, in a press release. Reasons for the rise in AF include increased longevity and a spike in risk factors such as hypertension, obesity, sleep apnea, and diabetes, he said.