HRS: AF & atrial flutter remain large cost burden in U.S.

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Patients with atrial fibrillation (AF) and atrial flutter (AFL), especially those who are similar to the ATHENA trial patient population, have high readmission rates and inpatient costs, which lead to greater overall costs, according to two studies presented at the 32nd annual Heart Rhythm Society (HRS) scientific sessions in San Francisco last week.

“For these studies, we took the patient selection criteria from the ATHENA trial and chose that specific patient population from two databases to assess what impact these two disease states have on continuum of care transmissions, healthcare quality, length of stay and readmissions, along with their cost burdens,” the studies’ lead author Alpesh N. Amin, MD, MBA, professor and chairman of the department of medicine and executive director of the hospitalist program at the University of California, Irvine, told Cardiovascular Business News.

As in ATHENA, the two studies included patients who were at least 75 years old, or at least 70 years old with at least one other risk factor (hypertension, diabetes, systemic embolism or stroke/transient ischemic attack).

“We were seeking to discover the real-life clinical outcomes and costs associated with these patient populations,” Amin explained. “Atrial fibrillation is a growing healthcare problem in the U.S., and it’s important that we know how often they are being readmitted to the hospitals, and how much it’s costing the healthcare system, especially because Medicare is pointing to $12 billion of its $17 billion spent on readmissions as avoidable.”

The first retrospective study, which took patients from the MarketScan Medicare database, sought to assess the incremental cost burden of AF and AFL to U.S. payors by comparing healthcare costs in ATHENA-like patients versus non-AF/AFL patients. The MarketScan database included patients who had at least one inpatient or at least two outpatient AF/AFL claims from January 2007 to March 2008 and at least 12 months of continuous enrollment pre/post the first claim.

The non AF/AFL patients were matched 1:1 to the AF/AFL patients on age, gender, region and enrollment status. The researchers included 58,555 patients (mean age 80.2 years, 51.2 percent men) in the cohort.

Amin et al found that the AF/AFL patients had more post-index admissions (mean 0.72 vs. 0.21 per patient), outpatient claims (73.8 vs. 37.1 per patient) and prescription claims (45 vs. 29.5 per patient). The AF/AFL patients had higher overall inpatient costs (incremental difference $5,694), outpatient costs ($3,258) and prescription costs ($467), as well as cardiovascular-related inpatient costs ($5,914) and outpatient costs ($1,874).

Therefore, the researchers concluded that the incremental medical costs of ATHENA-like AF/AFL patients are mainly due to higher cardiovascular-related inpatient costs, and the cost burden persists after controlling for cardiovascular morbidity.

In general, the main cost burden associated with AF/AFL is related to hospitalizations—the first and the readmissions associated with the disease states, said Amin.

In the second study, he and his colleagues respectively examined the patterns of rehospitalization (all-cause, cardiovascular and AF/AFL-related) over a one year period for ATHENA-like AF/AFL patients using the PharMetrics Patient-Centric database.

Overall, the researchers included 3,498 patients (mean age 80 years, 42.4 percent men). Post-index, 39.7 percent of patients were hospitalized for any cause (mean 1.73 events per patient), with 35 percent undergoing cardiovascular-related (1.56 events per patient) and 26.7 percent AF-related hospitalizations (1.39 events per patient).

They reported that the common causes for cardiovascular-related readmission were AF/AFL (47.5 percent), congestive heart failure (9.9 percent), coronary artery disease (7.4 percent) and stroke/transient ischemic attack (6.2 percent).

Importantly, Amin and colleagues found that readmissions with a primary diagnosis of AF/AFL were longer than the initial hospitalization (mean total 6.9 versus 4.3 days), and more costly (mean total payment $4,418 vs. $3,589; mean total allowed amount $13,134 vs. $11,060).

Therefore, they concluded that the ATHENA-like AF/AFL patients have higher readmission rates, and these readmissions incur higher costs than the initial AF/AFL admission.

Amin asked: “How can we tackle such a large quality and cost burden under the current fee-for-service model? We are still rewarding