Impact of Atrial Fibrillation Burden on Health Care Costs and Utilization.
| Autor: | Peigh G; Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA., Zhou J; Medtronic Inc, Minneapolis, Minnesota, USA., Rosemas SC; Medtronic Inc, Minneapolis, Minnesota, USA., Roberts AI; Medtronic Inc, Minneapolis, Minnesota, USA; Brown University School of Public Health, Providence, Rhode Island, USA., Longacre C; Medtronic Inc, Minneapolis, Minnesota, USA., Nayak T; Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA., Schwab G; Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA., Soderlund D; Medtronic Inc, Minneapolis, Minnesota, USA., Passman RS; Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA. Electronic address: rod.passman@nm.org. |
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| Jazyk: | angličtina |
| Zdroj: | JACC. Clinical electrophysiology [JACC Clin Electrophysiol] 2024 Apr; Vol. 10 (4), pp. 718-730. Date of Electronic Publication: 2024 Feb 28. |
| DOI: | 10.1016/j.jacep.2023.12.011 |
| Abstrakt: | Background: Integrating patient-specific cardiac implantable electronic device (CIED)-detected atrial fibrillation (AF) burden with measures of health care cost and utilization allows for an accurate assessment of the AF-related impact on health care use. Objectives: The goal of this study was to assess the incremental cost of device-recognized AF vs no AF; compare relative costs of paroxysmal atrial fibrillation (pAF), persistent atrial fibrillation (PeAF), and permanent atrial fibrillation (PermAF) AF; and evaluate rates and sources of health care utilization between cohorts. Methods: Using the de-identified Optum Clinformatics U.S. claims database (2015-2020) linked with the Medtronic CareLink database, CIED patients were identified who transmitted data ≥6 months postimplantation. Annualized per-patient costs in follow-up were analyzed from insurance claims and adjusted to 2020 U.S. dollars. Costs and rates of health care utilization were compared between patients with no AF and those with device-recognized pAF, PeAF, and PermAF. Analyses were adjusted for geographical region, insurance type, CHA Results: Of 21,391 patients (mean age 72.9 ± 10.9 years; 56.3% male) analyzed, 7,798 (36.5%) had device-recognized AF. The incremental annualized increased cost in those with AF was $12,789 ± $161,749 per patient, driven by increased rates of health care encounters, adverse clinical events associated with AF, and AF-specific interventions. Among those with AF, PeAF was associated with the highest cost, driven by increased rates of inpatient and outpatient hospitalization encounters, heart failure hospitalizations, and AF-specific interventions. Conclusions: Presence of device-recognized AF was associated with increased health care cost. Among those with AF, patients with PeAF had the highest health care costs. Mechanisms for cost differentials include both disease-specific consequences and physician-directed interventions. Competing Interests: Funding Support and Author Disclosures Dr Passman has received research support from the American Heart Association (#18SFRN34250013) and the National Institutes of Health (UG3HL165065); has received research support and speaker fees from Medtronic; has received research support from Abbott; and has received royalties from UpToDate. Ms. Zhou, Rosemas, Soderlund, and Longacre are employees and shareholders of Medtronic. Mr Roberts is a contractor with Medtronic. Northwestern University has received fellowship support from Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.) |
| Databáze: | MEDLINE |
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