Atrial Fibrillation: The Growing Cost of Hospitalization

JUNE 06, 2014
Jeannette Y. Wick, RPh, MBA, FASCP
A recent investigation found a significant increase in hospitalization rates for patients with atrial fibrillation in the United States.

The US health care system is learning more about atrial fibrillation (AF) and its repercussions. Two facts, addressed in a study published in the online version of Circulation, underscore why AF is a research priority. First, approximately $6.7 billion in 2005 alone was spent in the United States to treat patients with nonvalvular AF, with about 75% of the expenditure going to inpatient care. Second, hospitalization rates for AF among US adults exploded between 2000 and 2010 and the trend is expected to continue. The result: AF is a significant public health burden.

Researchers from several leading medical facilities across the nation conducted this investigation to identify trends in patient characteristics, outcomes, and comorbid diagnoses. The researchers used the Nationwide Inpatient Sample (NIS) from 2000 through 2010 to identify AF-related hospitalizations. Between 2000 and 2010, AF hospitalizations increased by 23%, with patients older than 65 years most likely to be affected. Almost 38% of hospitalizations occurred in the “Stroke Belt”—the southern part of the United States, where higher rates of hypertension, diabetes, and heart failure create an excess risk of stroke.

Hypertension (60%), diabetes (21.5%), and chronic pulmonary disease (20%) were AF’s most common comorbidities. Approximately 1% of patients died in the hospital, with patients who had heart failure or who were older than 80 years most likely to die. However, over the 11-year period, in-hospital mortality declined from 1.2% to 0.9%.

The mean length of stay (LOS) was 3 days, and it remained stable between 2000 and 2010. Associated costs did not. In 2001, the cost to hospitalize a patient with AF was $6410. It rose to $8439 in 2010 after adjusting for inflation, representing a 24% increase. The researchers attribute the increase to the tendency for AF patients to be older and more medically complex, and the increasing likelihood of discharge from the hospital to another facility.

The researchers suggest that the best cost control approach will look at limiting hospitalizations and LOS. They cite other studies that demonstrate that using emergency department observation, rate control (as opposed to rhythm control), and use of low molecular weight heparin as potential interventions could reduce costs.

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.


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