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Resource utilization and outcomes in patients with atrial fibrillation: a case control study
Rachael Boggon1, Gregory Y H Lip, Arlene M Gallagher
1Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK.
Background:
Atrial fibrillation (AF) is the most common sustained disorder of cardiac rhythm. Various new anticoagulation and antiarrythmic treatments are being investigated for the treatment of AF. Before novel treatments can be used widely in actual clinical practice, the cost effectiveness of such novel treatments may need to be determined.
Objective:
The objectives of the study were to describe resource utilization for AF and control patients, and estimate the incidence of mortality.
Methods:
This case control study evaluated 6 months of primary and secondary care resource utilization and mortality rates for patients within the period 01 April 2001 to 31 March 2006. Cases included 15 373 adults with a record of AF in the General Practice Research Database (GPRD) within the study period. The index date was randomly selected between 6 months after the AF record and end of data collection. Cases were matched to controls by age, gender, general practice and time.
Results:
AF patients had significantly higher resource utilization than controls. Resource utilization increased with greater National Institute for Clinical Excellence (NICE) stroke risk strata (graded as low, moderate or high based on associated risk factors). Both current warfarin and aspirin users had higher resource utilization than control patients. Resource utilization remained high amongst AF patients who discontinued therapy. The mortality rate was significantly higher in AF patients than controls, deaths due to circulatory system disease were increased 4-fold and cancer deaths were doubled. All-cause and circulatory mortality rates, as well as rates of clinical outcomes, were related to the NICE stroke risk schema.
Conclusions:
There was large heterogeneity in resource utilization between AF patients, although overall, this was still higher than controls without AF. Higher resource utilization was evident in patients at higher risk of stroke, and remained where antithrombotic therapy was discontinued. The mortality risk in AF was increased substantially, both for cardiovascular and non-cardiovascular causes of death, indicating a large unmet medical need.
Insights
Atrial fibrillation (AF) patients incur higher healthcare costs and mortality than controls. Resource use increases with stroke risk, even after discontinuing therapy, highlighting an unmet need.
Area of Science:
- Cardiology
- Health Economics
- Public Health
Background:
- Atrial fibrillation (AF) is a common cardiac rhythm disorder.
- Novel treatments for AF require cost-effectiveness evaluation before clinical adoption.
Purpose of the Study:
- To describe resource utilization in AF patients compared to controls.
- To estimate mortality incidence in AF patients.
Main Methods:
- A case-control study analyzed 15,373 adult AF patients from the General Practice Research Database (GPRD).
- Resource utilization and mortality were assessed over six months, comparing AF patients to matched controls.
- National Institute for Clinical Excellence (NICE) stroke risk strata were used to categorize risk.
Main Results:
- AF patients exhibited significantly higher resource utilization than controls.
- Resource utilization escalated with increasing NICE stroke risk strata.
- Mortality rates were substantially higher in AF patients, with increased deaths from circulatory diseases and cancer.
Conclusions:
- Significant heterogeneity in resource utilization exists among AF patients, yet overall utilization remains higher than in non-AF controls.
- Higher stroke risk and discontinuation of antithrombotic therapy correlated with increased resource utilization.
- AF presents a substantial unmet medical need due to increased cardiovascular and non-cardiovascular mortality risk.
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