Association between economic and arrhythmic burden of paroxysmal atrial fibrillation in patients with cardiac implanted electronic devices
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Updated: Oct 12, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Derek S Chew1, Zhen Li2, Benjamin A Steinberg3
1Duke Clinical Research Institute, Duke University, Durham, NC; Libin Cardiovascular Institute, University of Calgary, AB, Canada.
Insights
Higher atrial fibrillation (AF) burden in patients with cardiovascular implantable electronic devices (CIEDs) is linked to increased healthcare costs. Reducing AF burden through targeted strategies may lower these significant annual expenses.
Area of Science:
- Cardiology
- Health Economics
- Medical Device Technology
Background:
- Rising atrial fibrillation (AF) prevalence necessitates understanding associated healthcare costs.
- The link between AF burden and healthcare expenditure remains unclear.
- Older adults with paroxysmal AF and newly implanted cardiovascular implantable electronic devices (CIEDs) are a key population for cost analysis.
Purpose of the Study:
- To assess the association between AF burden and healthcare costs in patients with paroxysmal AF and CIEDs.
- To quantify the relationship between device-detected AF burden and annual healthcare expenditures.
- To identify potential cost-saving opportunities through AF burden reduction.
Main Methods:
- A longitudinal cohort study linked CIED remote-monitoring data with Medicare claims for 39,345 patients (2010-2016).
- AF burden was defined as the 30-day averaged daily percentage of time in AF.
- Statistical analysis examined the association between AF burden and total 1-year healthcare costs.
Main Results:
- The mean total 1-year cost was $18,668, with hospitalizations (two-thirds for heart failure) driving costs.
- Increasing AF burden correlated with rising healthcare costs, from $17,860 (0% AF) to $20,968 (5-98% AF).
- A linear relationship was observed: a 10% increase in daily AF duration was associated with a 3.1% increase in 1-year costs (P < .001).
Conclusions:
- Higher AF burden in older patients with paroxysmal AF and CIEDs is associated with increased healthcare costs.
- Observational data suggest that interventions reducing AF burden may lower associated healthcare expenditures.
- Further prospective studies are needed to confirm causality and evaluate cost-effectiveness of AF-targeted strategies.
Background:
As the prevalence of atrial fibrillation (AF) increases, a greater understanding of the costs associated with AF care is required. While individuals with greater arrhythmic burden may interact with the health system more frequently, the relationship between AF burden and costs remains undefined.
Methods:
In a longitudinal patient cohort with paroxysmal AF and newly implanted cardiovascular implantable electronic devices (CIED) (2010-2016), we linked CIED remote-monitoring data with Medicare claims to assess the association between the 30-day averaged device-detected daily percentage of time in AF ("AF burden") and healthcare costs.
Results:
Among 39,345 patients, the mean age was 77.1 ± 8.7 years, 60.7% were male, and the mean CHA2DS2-VASc score was 4.9 ± 1.3. The mean total 1-year costs were $18,668 ± 29,173, driven by hospitalization costs where two-thirds of admissions were due to heart failure. Increasing AF burden was associated with increasing costs: $17,860 ± 28,525 for 0% daily AF burden; $18,840 ± 29,104 for 0-5% daily AF burden; and $20,968 ± 31,228 for 5-98% daily AF burden. There was a linear relationship between AF burden expressed as a continuous variable and 1-year costs (adjusted cost rate ratio 1.031 per 10% daily duration in AF, 95% confidence interval 1.023-1.038; P < .001).
Conclusions:
Among older patients with paroxysmal AF and CIEDs, increasing AF burden is associated with higher healthcare costs. As the observational study design is unable to determine causal relationships, prospective study is required to explore the intriguing hypothesis that targeted AF strategies, including comorbidity management, that reduce AF burden may also reduce the high annual costs associated with AF.
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