The price of irregular heart rate

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a_fibAtrial fibrillation (AF) increased 13% in prevalence over the last twenty years in the United States alone. Its incidence is expected to climb further, and is predicted to affect 15.9 million individuals by 2050. Atrial fibrillation is the most common type of arrhythmia, which indicates irregular heart rhythm. The growing numbers are attributed to our ageing population and its association with a higher risk of developing stroke, dementia, heart failure, and death. Jonathan Bathcelor writes about the impact of AF on our society, emphasizing that mounting AF cases is not an only a public health challenge but an economic burden within our society. In the UK, reports indicate a 50% increase over a 5 year period (1995-2000) in direct costs of AF.

Bathcelor cites studies conducted in many countries, that conclude a major factor driving costs of atrial fibrillation is hospitalizations. Within the United States, Kim and colleagues uncovered that that hospitalizations account for 80% of all annual costs. Their data showed that, for these patients, inpatient costs were $11,307 per individual, and outpatient costs were $2,827 per individual (a total of $14,134 per patient). This trend is evident in many European countries as well, as German researchers, Reinhold and colleagues, calculated that 78% of the annual average cost of AF was attributable to inpatient stays. In addition, they found that more than 50% of total annual costs are caused in the first three months following the onset of AF, and about 80% of annual costs are incurred in the first six months.

Recent studies reveal other factors affecting high AF costs, which vary across nations. For example, valvular heart disease is associated directly with AF expenses in Greece, Italy, and Spain, whereas diabetes and stroke drive AF costs in Poland. In the United States, adverse events secondary to AF therapy were linked to higher AF costs, with mean annual per-patient costs of $3,089

Batchelor concludes: hospitalizations of patients with AF are the primary drivers of overall cost and represent a significant economic burden. Any clinical management strategy that reduced hospitalizations in this vulnerable population would go a long way toward improving clinical outcomes in a cost-effective way.