The Trends of Atrial Fibrillation-Related Hospital Visit and Cost, Treatment Pattern and Mortality in Korea: 10-Year Nationwide Sample Cohort Data

Abstract

Background and ObjectivesThe change of in-hospital and out-hospital treatments, and hospital costs for atrial fibrillation (AF) were not well known in rapidly aging Asian countries. This study is to examine the trends of AF management and outcomes in Korea.Subjects and MethodsIn the sample cohort from Korean National Health Insurance Data Sample Cohort (K-NHID-Sample Cohort) from 2004 through 2013, we identified patients with AF and hospital visit records using Korean Classification of Diseases, 6th Revision (KCD-6). Hospital cost, prescribed medications, radiofrequency catheter ablation (RFCA), morbidity and mortality were identified.ResultsAF-related hospitalization and outpatient clinic visits increased by 2.19 and 3.06-fold, respectively. While the total cost increased from 3.6 to 11.3 billion won (p<0.001), the mean cost per patient increased from 0.68 to 0.83 million won (p<0.001). Although the mean CHA2DS2-VASc score increased from 3.5 to 4.4 in the total AF population, the proportion of patients who receive anticoagulation therapy with warfarin showed no significant change for the decade. The proportion of hospitalization for RFCA was increased (0.4% to 1.1%, p<0.001). All-cause mortality (6.7% to 5.0%), cardiovascular mortality (1.4% to 1.1%) and stroke-related death (1.3% to 0.8%) showed a modest decrease from 2004 to 2013.ConclusionDuring the last decade, AF-related hospitalization and outpatient clinic visits have increased with the increase of many other comorbidities, whereas the rate of anticoagulation did not improved. Although mortality in patients with AF showed a modest decrease from 2004 to 2013, proper anticoagulation therapy is warranted for the improvement of public health.

Application of the simple atrial fibrillation better care pathway for integrated care management in frail patients with atrial fibrillation: A nationwide cohort study

“…We performed a retrospective analysis of data from the national health claims database (NHIS-2016-4-026) established by the National Health Insurance Service (NHIS) of Korea. [1][2][3] The NHIS is a single insurer managed by the Korean government, and the majority (97.1%) of the Korean population are mandatory subscribers, with the remaining 3% of the population being medical aid subjects.…”

“…Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia among elderly individuals, [1][2][3] and it has enormous socioeconomic implications given the risk of mortality and morbidity resulting from stroke, congestive heart failure, dementia, and impaired quality of life. [1][2][3][4][5] Frailty is also associated with more adverse clinical outcomes in elderly individuals admitted to the hospital. AF may be a marker of frailty in elderly individuals and may be related to a loss of independence in performing activities of daily living.…”

Outcomes of Rate-Control Treatment in Patients With Atrial Fibrillation and Heart Failure ― A Nationwide Cohort Study ―

“…1 In our previous report on a Korean nationwide semi-dynamic cohort, hospital visits and costs for AF increased with the increase in comorbidities during the past decade. 2 Uncontrolled rapid ventricular rate during AF can lead to left ventricular systolic dysfunction and consequent heart failure (HF). In addition, AF and HF affect each other, contributing to increased cardiovascular morbidity and mortality.…”

Favorable neurological outcome after ischemic cerebrovascular events in patients treated with percutaneous left atrial appendage occlusion compared with warfarin

“…Atrial fibrillation (AF) is the most common arrhythmia and is associated with increased morbidity and mortality, including from thromboembolic stroke. 1,2 Over 90% of thrombi originate from left atrial appendage (LAA) in nonvalvular AF. 3 The thrombi in the LAA tend to be large and can result in larger and multiple cerebral infarctions.…”