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Impact of atrial fibrillation on mortality, stroke, and medical costs
P A Wolf1, J B Mitchell, C S Baker
1Department of Neurology, Boston University, Mass, USA. pawolf@bu.edu
Insights
Atrial fibrillation (AF) significantly increases mortality and stroke risk, especially in patients with cardiovascular disease (CVD). Managing AF and CVD can reduce mortality, stroke incidence, and healthcare costs.
Area of Science:
- Cardiology
- Public Health
- Health Economics
Background:
- The impact of atrial fibrillation (AF) on mortality, stroke, and healthcare costs remains unclear.
- Cardiovascular disease (CVD) prevalence necessitates understanding associated risks.
Purpose of the Study:
- To investigate the effects of atrial fibrillation (AF) on mortality, stroke incidence, and medical costs in hospitalized Medicare patients.
- To compare outcomes in patients with AF and CVD against a matched cohort without AF.
Main Methods:
- Prospective cohort study utilizing Medicare hospitalization data (MedPAR files).
- Matched comparison groups (n=26,753) with and without AF, including a separate cohort (n=14,267) for stroke rates.
- Multivariate and proportional hazard regression analyses adjusted for cumulative mortality, stroke, and costs.
Main Results:
- Patients with AF and CVD experienced a ~20% higher adjusted relative mortality risk over 3 years.
- Stroke incidence was 5-fold higher in individuals with CVD; AF increased stroke risk by ~25% in women and ~10% in men.
- AF was associated with significantly higher total Medicare spending (8.6- to 22.6-fold in men, 9.8- to 11.2-fold in women) in the first year, with sustained increases in subsequent years.
Conclusions:
- Preventing AF and effectively treating patients with AF and co-existing CVD are crucial.
- Interventions targeting AF and associated CVD can potentially reduce mortality, stroke rates, and healthcare expenditures.
Background:
The impact of atrial fibrillation (AF) on mortality, stroke, and medical costs is unknown.
Methods:
We conducted a prospective cohort study of hospitalized Medicare patients with AF and 1 other cardiovascular diagnosis (CVD) compared with a matched group without AF (n = 26,753), randomly selected in 6 age-sex strata from 1989 MedPAR files of more than 1 million patients diagnosed as having AF. Stroke rates were also determined in another cohort free of CVD (n = 14,267). Total medical costs after hospitalization were available from a 1991 cohort. Cumulative mortality, stroke rates, and costs following index admission were adjusted by multivariate and proportional hazard regression analyses.
Results:
Mortality rates were high in individuals with CVD, ranging from 19.0% to 52.1% in 1 year. Adjusted relative mortality risk was approximately 20% higher in patients with AF in all age-sex strata during each of the 3 years studied (P < .05). Incidence of stroke was high in individuals with CVD, 6.2% to 15.4% in 1 year, with and without AF, and was at least 5-fold higher than in individuals without CVD. In those with CVD, stroke rates were approximately 25% higher in women with AF (P < .05) but only 10% higher in men. Adjusted total Medicare spending in 1 year was 8.6- to 22.6-fold greater in men, and 9.8- to 11.2-fold greater in women with AF (P < .05). Second- and third-year costs were increased as well.
Conclusion:
Prevention of AF and treatment of patients with AF and associated CVD may yield benefits in reduced mortality and stroke as well as reducing health care costs.