Economic Burden of Undiagnosed Nonvalvular Atrial Fibrillation in the United States

Turakhia, Mintu P.; Shafrin, Jason; Bognar, Katalin; Goldman, Dana P.; Mendys, Philip; Abdulsattar, Younos; Wiederkehr, Daniel; Trocio, Jeffrey

doi:10.1016/j.amjcard.2015.05.045

Cited by 78 publications

(32 citation statements)

References 25 publications

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“…Investigators examined Medicare and Optum Touchstone databases (2004–2010) to estimate costs attributed to nonvalvular AF versus propensity-matched control subjects in 2014 US dollars 143 :…”

Section: Disorders Of Heart Rhythmmentioning

confidence: 99%

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

Benjamin¹,

Blaha²,

Chiuve³

et al. 2017

Circulation

7,578

5,040

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Section: Disorders Of Heart Rhythmmentioning

confidence: 99%

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

Benjamin¹,

Blaha²,

Chiuve³

et al. 2017

Circulation

7,578

5,040

View full text Add to dashboard Cite

“…These costs are very dependent on characteristics of the implementing healthcare system. Nevertheless, we investigate feasibility and expected behaviour using estimates for cost per person in the screening programme, as follows: Cost of screening, based on primary care clinician time: $10 or $20; cost of referral, based on a diagnostic ECG and cardiologist time: $400; cost of treatment with anticoagulants, and management costs [21] : $720; cost of non-diagnosis [21] – [23] which is the direct cost of stroke, assuming 7% of patients with untreated AFib experience strokes [21] : $60,000. This figure neglects indirect costs associated with stroke.…”

Section: Discussionmentioning

confidence: 99%

Screening for Atrial Fibrillation During Automatic Blood Pressure Measurements

Lowe

Stewart

2018

IEEE J. Transl. Eng. Health Med.

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Atrial fibrillation (Afib) contributes significantly to overall cardiovascular risk. Widespread screening for Afib in primary care is sometimes performed by palpation, but suffers from low accuracy and is dependent on clinician experience. Algorithms implemented on oscillometric blood pressure devices can detect Afib with high sensitivity and specificity, but information on factors affecting accuracy is scant. Concurrent diagnostic electrocardiogram (ECG) and oscillometry were measured in participants in ECG clinics at two sites. Root mean squared successive difference (RMSSD) and irregularity index (Irrx) were calculated from oscillometric data and used to train logistic regression classifiers. Monte Carlo cross validation with 20 splits was performed to estimate confidence intervals for mean sensitivity and specificity, with various weightings, in the absence or presence of ectopics, and with or without repeated measurements. 707 measurements, including 168 Afib, were collected from 569 participants with mean (standard deviation) age of 63 (16) years. Sensitivity/specificity of RMSSD and Irrx were 0.982/0.908 and 0.986/0.960 respectively when ectopics were included. Excluding ectopics from the data improved specificity by up to 5%. Nevertheless, based on this performance and after accounting for prevalence of Afib in the population aged over 60 years, and estimated costs of healthcare, oscillometric screening for Afib in this age group could return a positive net health-economic benefit.

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“…This identified 261 records, of which eight papers [99][100][101][102][103][104][105][106] not previously identified were considered relevant after title and abstract screening and a further four papers [107][108][109][110] were highlighted as providing information on costs.…”

Section: Outcomes Of the Economic Evaluationmentioning

confidence: 99%

Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis

Welton

McAleenan

Thom

et al. 2017

Health Technol Assess

118

116

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BackgroundAtrial fibrillation (AF) is a common cardiac arrhythmia that increases the risk of thromboembolic events. Anticoagulation therapy to prevent AF-related stroke has been shown to be cost-effective. A national screening programme for AF may prevent AF-related events, but would involve a substantial investment of NHS resources.ObjectivesTo conduct a systematic review of the diagnostic test accuracy (DTA) of screening tests for AF, update a systematic review of comparative studies evaluating screening strategies for AF, develop an economic model to compare the cost-effectiveness of different screening strategies and review observational studies of AF screening to provide inputs to the model.DesignSystematic review, meta-analysis and cost-effectiveness analysis.SettingPrimary care.ParticipantsAdults.InterventionScreening strategies, defined by screening test, age at initial and final screens, screening interval and format of screening {systematic opportunistic screening [individuals offered screening if they consult with their general practitioner (GP)] or systematic population screening (when all eligible individuals are invited to screening)}.Main outcome measuresSensitivity, specificity and diagnostic odds ratios; the odds ratio of detecting new AF cases compared with no screening; and the mean incremental net benefit compared with no screening.Review methodsTwo reviewers screened the search results, extracted data and assessed the risk of bias. A DTA meta-analysis was perfomed, and a decision tree and Markov model was used to evaluate the cost-effectiveness of the screening strategies.ResultsDiagnostic test accuracy depended on the screening test and how it was interpreted. In general, the screening tests identified in our review had high sensitivity (> 0.9). Systematic population and systematic opportunistic screening strategies were found to be similarly effective, with an estimated 170 individuals needed to be screened to detect one additional AF case compared with no screening. Systematic opportunistic screening was more likely to be cost-effective than systematic population screening, as long as the uptake of opportunistic screening observed in randomised controlled trials translates to practice. Modified blood pressure monitors, photoplethysmography or nurse pulse palpation were more likely to be cost-effective than other screening tests. A screening strategy with an initial screening age of 65 years and repeated screens every 5 years until age 80 years was likely to be cost-effective, provided that compliance with treatment does not decline with increasing age.ConclusionsA national screening programme for AF is likely to represent a cost-effective use of resources. Systematic opportunistic screening is more likely to be cost-effective than systematic population screening. Nurse pulse palpation or modified blood pressure monitors would be appropriate screening tests, with confirmation by diagnostic 12-lead electrocardiography interpreted by a trained GP, with referral to a specialist in the case of an unclear diagnosis. Implementation strategies to operationalise uptake of systematic opportunistic screening in primary care should accompany any screening recommendations.LimitationsMany inputs for the economic model relied on a single trial [the Screening for Atrial Fibrillation in the Elderly (SAFE) study] and DTA results were based on a few studies at high risk of bias/of low applicability.Future workComparative studies measuring long-term outcomes of screening strategies and DTA studies for new, emerging technologies and to replicate the results for photoplethysmography and GP interpretation of 12-lead electrocardiography in a screening population.Study registrationThis study is registered as PROSPERO CRD42014013739.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Economic Burden of Undiagnosed Nonvalvular Atrial Fibrillation in the United States

Cited by 78 publications

References 25 publications

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

Screening for Atrial Fibrillation During Automatic Blood Pressure Measurements

Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis

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