Report: AF burden high, resources scarce

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While the incidence of atrial fibrillation (AF) is becoming more prevalent in the U.S., a new state-by-state report showed that the financial impact of AF is much larger than resources available to patients with the condition. The report was developed by the AF Stat: A Call to Action for Atrial Fibrillation, a partnership with the George Washington University School of Public Health and Health Services.

The report, "AFib in America: State Impact Reports, showed that 2007 Medicare payments where AF was the primary diagnosis reached almost $2.3 billion, and more than 2.8 million Medicare beneficiaries, or 6 percent, utilized at least one healthcare service paid by Medicare where AF was the primary diagnosis.

The authors found that there is a regional pattern regarding AF services and the northeast and mid-Atlantic states see higher percentages compared with western states. In fact, in Connecticut, Delaware, New Hampshire and New Jersey, this number is more than 8 percent but is less than 4 percent in Hawaii and New Mexico.

And while the average payments per patient were an estimated $6,200 across the U.S., the payments ranged from $5,000 in Alabama to almost $10,800 in Alaska and $9,440 in Washington, D.C., varying largely by state.

These variations could be attributed to differences in the patterns of illness, the demand for services or local healthcare markets.

The report also found the following:

  • There were an estimated 16.9 million physician encounters where AF was the primary diagnosis. These encounters were spread across 2.6 million unique patients, an average of 6.2 encounters among beneficiaries;
  • There were a reported 4.2 million hospital outpatient visits by 875,000 patients, an average of 4.8 visits attributed to AF per person;
  • There were an estimated 212,600 emergency department  visit for AF in 2007 and two-thirds of those resulted in inpatient hospital stays; and
  • There was a reported 208,600 inpatient hospital stays for AF by 187,000 patients in 2007.

The report showed that primary hypertension was the leading comorbidity listed on Medicare claims for inhospital claims due to AF in 2007 (53.5 percent). Other comorbidities associated with AF were lipoid metabolism disorders (34 percent), forms of chronic ischemic heart disease (32.1 percent), heart failure (28 percent) and cardiac dysrhythmias (23.7 percent).

Of the 50 states, 42 receive funding from the Centers for Disease Control and Prevention (CDC) for heart disease and stroke prevention programs; however, some states, like New Hampshire and the District of Columbia, do not have resources dedicated to providing education to residents about AF.

“Unfortunately, our research reveals that there is very little information available for the public through state public health resources and AF,” the authors wrote. “Further, there are no state public health programs dedicated to supporting patients with AF.”

The authors concluded that several opportunities to promote better AF awareness and management policies could be developed by policymakers and health leaders. These could include:

  • Collecting better data about AF and its burden;
  • The CDC should include AF as part of its CVD and stroke prevention efforts;
  • Health and Human Services and the Centers for Medicare & Medicaid Services should increase their efforts related to AF awareness;
  • CDC should continue funding state collaborate efforts; and
  • States should work with national partners and other states to develop AF awareness resources for residents.

"Just as patients need to comprehensively manage their AF, health leaders need to develop and implement comprehensive programs that address the impact of AF in their home states," said Sen. Bill Frist, MD, R-Tenn., former policy advisor for AF Stat.

AF Stat is funded by Sanofi-Aventis.