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Hospitalizations, costs for AF rose from 2000 to 2010
Hospitalizations for atrial fibrillation in the United States rose 23% from 2000 to 2010, and the mean cost of AF hospitalization increased 24% from 2001 to 2010.
Nileshkumar J. Patel, MD, of Staten Island University Hospital in New York, and colleagues performed a cross-sectional study using the Nationwide Independent Sample (NIS) databases from 2000 to 2010. They analyzed all hospitalizations with AF as primary diagnosis, defined as ICD-9-CM code 427.31, of patients aged 18 years or older for whom age, sex, admission date, discharge date and in-hospital mortality data were available.
They identified comorbidities using Agency for Healthcare Research and Quality comorbidity measures and calculated estimated cost of hospitalization by merging NIS data with cost-to-charge ratios from the Healthcare Cost and Utilization Project and adjusting for inflation.
Hospitalizations for AF increased 23% during the study period. Most of those hospitalized were white (64.9%) and aged 65 years or older (69.8%).
The rate of AF hospitalization in the United States increased 14.4% from 2000 to 2010 (P<.001), according to the researchers. The greatest relative increases occurred in those aged 35 to 49 years (relative increase, 16.6%; P<.001) and in those 80 years or older (relative increase, 15.2%; P<.001).
The most frequent comorbidities in patients admitted with AF included hypertension (60%), diabetes (21.5%) and chronic pulmonary disease (20%).
The overall in-hospital mortality rate was 1%, and it was highest in those aged 80 years and older (1.9%) and in those with concomitant HF (8.2%), the researchers wrote. However, the in-hospital mortality rate decreased 29.2% during the study period, from 1.2% in 2000 to 0.9% in 2010.
Despite no change in mean or median length of stay (median length of stay, 3 days; interquartile range, 2-5) during the study period, mean cost of AF hospitalizations after adjustment for inflation increased 24% from 2001 to 2010 (P<.001). Cost was highest for patients with HF ($33,161) and valvular disorders ($28,030).
Length of stay and cost of AF hospitalization both increased in proportion to increase in CHADS2 score (P<.01), according to the results.
“Increasing number of hospitalizations, aging population, patient complexity and increasing disposition trend to another facility are some of the drivers of increasing cost,” Patel and colleagues wrote. “This represents a staggering economic burden on the health care system.”
Disclosure: One researcher reports consulting for Medtronic and St. Jude Medical.