Hospital and clinical care costs associated with atrial fibrillation for Medicare beneficiaries in the Cardiovascular Health Study and the Framingham Heart Study

Delaney, Joseph A.; Yin, Xiaoyan; Fontes, João D.; Wallace, Erin; Skinner, Asheley Cockrell; Wang, Na; Hammill, Bradley G.; Benjamin, Emelia J.; Curtis, Lesley H.; Heckbert, Susan R.

doi:10.1177/2050312118759444

Cited by 41 publications

(28 citation statements)

References 38 publications

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“…Noteworthy, AF remained significantly associated with an increased risk of death even after controlling for cardiovascular comorbidities (2,3). AF is also associated with an estimated incremental cost of US$18,601 in hospital and clinical care in the year after diagnosis, even after accounting for age, time period, and comorbidities (4).…”

Section: Introductionmentioning

confidence: 98%

Comparison of Inflammatory Mediators in Patients With Atrial Fibrillation Using Warfarin or Rivaroxaban

Martins

Duarte

Vieira

et al. 2020

Front. Cardiovasc. Med.

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Background: Atrial fibrillation (AF) is the most common arrhythmia associated with high risk of venous thromboembolism. Inflammatory mechanisms may be involved in the pathophysiology of AF and in the AF-related thrombogenesis, and patients with AF might benefit from the use of anticoagulants with anti-inflammatory properties. However, the evidence is still scarce, and it points out the need of trials seeking to investigate the levels of inflammatory mediators in patients with AF under different anticoagulant therapies. Therefore, this study was designed to define whether patients with AF treated either with an activated coagulation factor X (FXa) inhibitor (rivaroxaban) or with a vitamin K inhibitor (warfarin) present changes in peripheral levels of inflammatory mediators, mainly cytokines and chemokines. Methods: A total of 127 subjects were included in this study, divided into three groups: patients with non-valvular atrial fibrillation (NVAF) using warfarin (N = 42), patients with NVAF using rivaroxaban (N = 29), and controls (N = 56). Plasma levels of inflammatory mediators were quantified by immunoassays. Results: Patients with AF (both warfarin and rivaroxaban groups) presented increased levels of inflammatory cytokines in comparison with controls. The use of rivaroxaban was associated with decreased levels of inflammatory cytokines in comparison with warfarin. On the other hand, patients with AF using rivaroxaban presented increased levels of the chemokines (MCP-1 in comparison with warfarin users; MIG and IP-10 in comparison with controls). Conclusions: AF is associated with an inflammatory profile that was less pronounced in patients on rivaroxaban in comparison with warfarin users. Further studies are necessary to assess the clinical implications of our results and whether patients with AF would benefit from rivaroxaban anti-inflammatory effects.

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Section: Introductionmentioning

confidence: 98%

Comparison of Inflammatory Mediators in Patients With Atrial Fibrillation Using Warfarin or Rivaroxaban

Martins

Duarte

Vieira

et al. 2020

Front. Cardiovasc. Med.

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“…While a few studies have been conducted that evaluated AC treatment of patients with AF in the outpatient setting and found relatively poor compliance with treatment guidelines, although utilization of DOACs is increasing in the USA 17 , little is known of inpatient AC treatment practices, especially in regard to parenteral AC utilization. Furthermore, the incremental healthcare costs of AF patients compared to those without the condition are rising in the USA, with a significant amount of the total cost attributed to costs for hospitalizations for cardiovascular, stroke, and bleeding events 18,19 Given the growing clinical and economic burden of AF, it is important to have a greater understanding of the treatment patterns of hospitalized patients with AF. Thus, in this study we evaluated utilization of ACs and the predictors of treatment of patients with a diagnosis of AF during a hospital stay in the USA from 1 January 2016 through 30 September 2017, a very recent time period in which warfarin, dabigatran, rivaroxaban, and apixaban were all available in the USA for the indication of stroke risk reduction in patients with AF.…”

Section: Introductionmentioning

confidence: 99%

Utilization of anticoagulants and predictors of treatment among hospitalized patients with atrial fibrillation in the USA

Deitelzweig

Dhamane

Fusco

et al. 2020

Journal of Medical Economics

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Objective: To evaluate utilization of anticoagulants (ACs) and the predictors of treatment of patients with a diagnosis of atrial fibrillation (AF) during a hospital stay in the USA. Methods: Patients (!18 years of age) who had a primary or secondary discharge diagnosis code of AF during a hospitalization (without a diagnosis of venous thromboembolism) were identified from the Premier Hospital database (1 January 2016-30 September 2017). AC treatments were examined during hospitalizations to assign AF patients into 3 study cohorts: those who received an oral AC (OAC), those who received parenteral AC only, and those who did not receive AC therapy. Multivariable logistic regression analyses were carried out to evaluate potential predictors of receiving parenteral AC only vs. OAC therapy, no AC therapy vs. OAC therapy, as well as the specific OAC drug choices. Results: Of the patients hospitalized with an AF diagnosis (n ¼ 482,729; mean age: 74.7 years; 46.8% female; 82.9% White; 79.4% with Medicare), 42.6% received OAC therapy (most commonly, warfarin or apixaban), 35.3% parenteral AC only, and 22.2% no AC therapy. A key predictor of not receiving OAC therapy was having an AF diagnosis in the second position (applicable to 87.4% of study population). Greater comorbidity level and prior baseline bleeding were strong predictors of receiving parenteral AC only or not receiving any AC therapy vs. receiving OAC therapy. Predictors of receiving warfarin vs. apixaban included higher stroke risk and prior baseline bleeding. Limitations: OAC utilization may have been underestimated since outpatient OAC utilization was not included in the analysis. Conclusions: A substantial portion of hospitalized AF patients did not receive any AC therapy, particularly those patients with an AF diagnosis in the second position on hospital records. The predictors of inpatient AC treatment that were identified may be helpful in the clinical decision-making process for patients who are hospitalized with AF.

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“…13 Hospitalizations for AF have increased markedly and costs for AF treatment have soared. 14 Recent reports suggest that improving self-management of risk factors for AF such as hypertension, lipids, obesity, elevated blood glucose, and increasing physical activity plays an important role in stemming progression of AF and are associated with lower costs for AF-related care. 15 – 17 Langseth et al reported that engaging in shared decision making for treatment options resulted in lower treatment costs.…”

Section: Introductionmentioning

confidence: 99%

Patient activation for self-management is associated with health status in patients with atrial fibrillation

McCabe¹,

Stuart-Mullen²,

McLeod³

et al. 2018

PPA

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BackgroundHigher levels of patient activation for self-managing health are associated with positive clinical and health care utilization outcomes. Identifying a patient’s activation level can guide clinicians to tailor interventions to improve their health. Effective self-management of atrial fibrillation (AF) requires patient activation to participate in treatment decisions, prevent complications, and manage risk factors. Yet, little is known about activation in patients with AF. The purpose of this descriptive study was to identify patient activation levels and factors associated with activation in patients with AF.MethodsPatients (N=123), 66% male, with a mean (SD) age of 59.9 (11.3) years seeking treatment for AF at an arrhythmia clinic completed the Patient Activation Measure (PAM), Atrial Fibrillation Severity Scale, Knowledge about Atrial Fibrillation test, Hospital Anxiety Depression Scale, Godin Leisure-Time Exercise Questionnaire, and Patient Assessment of Chronic Illness Care. Sociodemographic and clinical data were obtained from medical records. PAM scores were categorized into Levels 1–4. Associations among patient-reported outcomes, sociodemographic, and clinical variables were analyzed using Fisher’s exact tests and Kruskal–Wallis procedures.ResultsThe PAM scores of nearly half (45.5%) of the patients were at Level 3, while the scores of 38% were at Level 4. Male sex (P=0.02), higher education (P=0.004), being employed (P=0.005), lower body mass index (P=0.03), tobacco abstinence (P=0.02), less AF symptom burden (P=0.006), less depression (P≤0.0001) and anxiety (P=0.006), greater knowledge of AF (P=0.01), and higher levels of physical activity (P=0.02) were associated with higher activation levels.ConclusionHigher levels of patient activation in those with AF were associated with a more positive health status and educational attainment. Additional research to describe activation in patients with AF is warranted to identify patients at risk for low activation and to tailor interventions to activation level.

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Hospital and clinical care costs associated with atrial fibrillation for Medicare beneficiaries in the Cardiovascular Health Study and the Framingham Heart Study

Cited by 41 publications

References 38 publications

Comparison of Inflammatory Mediators in Patients With Atrial Fibrillation Using Warfarin or Rivaroxaban

Comparison of Inflammatory Mediators in Patients With Atrial Fibrillation Using Warfarin or Rivaroxaban

Utilization of anticoagulants and predictors of treatment among hospitalized patients with atrial fibrillation in the USA

Patient activation for self-management is associated with health status in patients with atrial fibrillation

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