AJC: Strategies needed to lower admissions for AF, flutter patients

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Because a large proportion of patients affected by atrial fibrillation (AF) or atrial flutter are older when they are hospitalized, the Medicare system takes a big financial hit. Implementing measures to lower readmission rates could help lessen the blow to the Medicare system and reduce the high cost burden associated with treating these AF and atrial flutter patients, according to a study published online first  Nov. 28 in the American Journal of Cardiology.

“The cost of managing AF is substantial, largely driven by inpatient costs, and is projected to increase as the population ages,” Gerald V. Naccarelli, MD, of the Penn State Heart and Vascular Institute in Hershey, Pa., and colleagues wrote. In fact, the researchers estimated that the number of Medicare patients diagnosed with AF increased from 3.2 percent in 1992 to 6 percent in 2002, and that rate is even higher now.

Because little data exists outlining the cost burden and the hospitalization trends of AF and atrial flutter patients, Naccarelli et al performed a real-world evaluation of the burden of hospitalization in patients age 65 years or older who were diagnosed with AF or atrial flutter using the U.S. Thomson Reuters MarketScan Medicare Supplemental and Coordination of Benefits Database. The database includes data from 2004 to 2007.

The researchers identified 55,774 patients with AF or atrial flutter; patients had a mean age of 77.9 years and 52.2 percent were male. Of the 55,774 patients evaluated, 51.9 percent were hospitalized and 2.9 percent died in the hospital.

According to the researchers, more patients were hospitalized for non-CV causes compared with CV causes, 35.6 percent vs. 27.2 percent. Of the deaths that were CV related, the culprit was most frequently major bleeding, followed by TIA or stroke.

Notably, patients diagnosed with AF or atrial flutter had more CV comorbidities including hypertension (80.5 percent), structural heart disease (32.9 percent), coronary artery disease (23.1 percent) and diabetes (19 percent).

“The high rehospitalization rate observed in this study exemplifies the need to drastically reduce unplanned rehospitalization to improve patient well-being and reduce costs,” according to the authors. Naccarelli and colleagues offered that initiatives such as the American College of Cardiology and Institute for Healthcare Improvement-led Hospital to Home initiatives could help to reduce hospital readmissions and improve the transition of care from the inpatient to outpatient setting.

The fact that most of the fatal CV-related hospitalizations were due to intracranial or gastrointestinal hemorrhage could be related to warfarin use, the authors noted. “These findings highlight the importance of optimizing the use of anticoagulants and seeking novel methods of reducing hospitalization and inpatient mortality.”

The prevalence of AF and atrial flutter in the U.S. is expected to rise from 3.4 million to nearly 8 million over the next 30 to 40 years, making it imperative that strategies be put in place to reduce the rates of readmission for these patients to reduce costs, they argued.

“A future area of research would be to examine the influence of patient baseline characteristics (e.g., age, gender, and comorbidites) on hospitalization and inpatient mortality rates; potentially this would help identify susceptible patient subgroups,” the authors concluded.