Changing Trends of Hospital Utilization in Patients After Their First Episode of Atrial Fibrillation

Abstract

A marked increase in hospitalization for patients with AF has previously been noted. Whether this increase was related to a change in the prevalence of AF, or change in the pattern of practice with respect to the management of AF remains unclear. To determine the trends in hospital utilization after first atrial fibrillation (AF) in a community-based setting, Olmsted County, Minnesota residents diagnosed with first AF during 1980-2000 were identified and followed until 2004. The primary outcome of interest was hospital admission for cardiovascular reasons. Of a total of 4,498 subjects (73±14 years old, 51% men), 2,503 (56%) were admitted to the hospital for cardiovascular causes for at least once during a mean follow-up of 5.5±5.0 years. The risk of first hospitalization was greatest during the first year of AF [cumulative incidence 31%, 95% confidence interval (CI) 30-32%]. First hospitalization was strongly related to age (P<0.0001), but not with sex (P=0.38). During 1980-2000, the age-and sex-adjusted rate of first hospitalization increased, on average, by 2.5% a year (95% CI 1.8-3.2%, P<0.0001), even after multivariable adjustment for comorbidities. When we excluded all hospital admissions for the purposes of AF management, the increase in hospitalization was only 0.8% per year (95% CI 0.05-1.6%, P=0.04), which was no longer significant after multivariable adjustment for comorbidities (P=0.25). In conclusion, the marked increase in hospitalization after first AF diagnosis during 1980-2000 appeared to be largely driven by the changing practice pattern in AF management.

Cost Burden of Cardiovascular Hospitalization and Mortality in ATHENA‐Like Patients With Atrial Fibrillation/Atrial Flutter in the United States

“…Similar findings were reported in a recent United States community-based study, with AF accounting for 26.4% of hospitalizations, CHF 21.7%, coronary/peripheral arterial causes 21.6%, and thromboembolic events 10.5%. 4 Notably, in both studies, although AF was the most common reason for CV hospitalizations, most hospitalizations were due to other CV conditions.…”

“…11,12 Although effective treatments are available to maintain and restore sinus rhythm in AF/AFL patients, 13 these have had little impact on hospitalization rates, which have tended to rise year-on-year. 4,14,15 Recently, the ATHENA trial (A placebo-controlled, double-blind, parallel arm Trial to assess the efficacy of dronedarone 400 mg bid for the prevention of cardiovascular Hospitalization or death from any cause in patiENts with Atrial fibrillation/atrial flutter) demonstrated that dronedarone, a novel antiarrhythmic therapy, significantly reduced the risk of hospitalization for CV causes or inpatient death from any cause in patients with AF/AFL. 16 There is currently limited information on the real-world cost of hospitalizations or inpatient deaths due to specific CV causes among AF/AFL patients.…”

Clinical, Economic, and Quality of Life Impact of Atrial Fibrillation

“…16 The likelihood of hospitalization was greatest during the first year after diagnosis of AF, with a cumulative incidence of hospitalization of 31%. The cumulative incidence of hospitalization 3 years and 5 years after diagnosis of AF was 48% and 59%, respectively.…”

Retinal vein and artery occlusions: a risk factor for stroke in atrial fibrillation

“…One in five strokes is caused by atrial fibrillation [2], and patients with atrial fibrillation have a five-fold increased risk of stroke [3]. Strokes in patients with atrial fibrillation are associated with higher mortality and cause more severe disability -thus, stroke prevention in patients with atrial fibrillation is an essential part of management [2,4].…”