Emergency Department Visits for Atrial Fibrillation in the United States: Trends in Admission Rates and Economic Burden From 2007 to 2014

Abstract

BackgroundAtrial fibrillation (AF) is an increasingly prevalent public health problem and one of the most common causes of emergency department (ED) visits. We aimed to investigate the trends in ED visits and hospital admissions for AF.Methods and ResultsThis is a repeated cross‐sectional analysis of ED visit‐level data from the Nationwide Emergency Department Sample for 2007 to 2014. We identified adults who visited EDs in the United States, with a principal diagnosis of AF. A sample of 864 759 ED visits for AF, representing a weighted total of 3 886 520 ED visits, were analyzed. The annual ED visits for AF increased by 30.7% from 411 406 in 2007 (95% confidence interval, 389 819–432 993) to 537 801 (95% confidence interval, 506 747–568 855) in 2014. Patient demographics remained consistent, with an average age of 69 to 70 years and slight female predominance (51%–53%) throughout the study period. Hospital admission rates were stable at ≈70% between 2007 and 2010, after which they gradually declined to 62% in 2014 (P trend=0.017). Despite the decline in hospital admission rates, AF hospitalizations increased from 288 225 in 2007 to 333 570 in 2014 because of the increase in total annual ED visits during the study. The adjusted annual charges for admitted AF patients increased by 37% from $7.39 billion in 2007 to $10.1 billion in 2014.ConclusionsAnnual ED visits and hospital admissions for AF increased significantly between 2007 and 2014, despite a reduction in admission rates. These data emphasize the need for widespread implementation of effective strategies aimed at improving the management of patients with AF to reduce hospital admissions and the economic burden of AF.

Predicting spontaneous conversion to sinus rhythm in symptomatic atrial fibrillation: The ReSinus score

“…Atrial fibrillation is among the most frequent arrhythmias encountered in the acute care sector and places an increasingly critical economic burden on health care systems, 38,39 mainly driven by treatment associated complications and costs of hospitalization. 14 Emergency department visits and hospitalizations for atrial fibrillation are increasing, 10,40 stressing the importance of strategies aimed at personalizing acute management decisions to reduce hospital admissions for unnecessary cardioversions, treatment complications and associated health care costs.…”

“…Deferred cardioversion in patients with a low probability of spontaneous conversion may result in an unjustified treatment delay and increased risk of stroke, heart failure and progression to persistent atrial fibrillation, [4][5][6] Conversely, patients who are likely to convert to sinus rhythm spontaneously, but undergo early pharmacological or electrical cardioversion may be unnecessarily hospitalized and exposed to the risk of postconversion arrhythmias and complications by general anesthesia or antiarrhythmic drugs. 7,8 Given the rising prevalence 9 and economic burden 10 of atrial fibrillation, several decision aids have been developed to facilitate the estimation of a patients' individual stroke, bleeding and mortality risk, thus guiding safe and effective long-term management. 11,12 A tool to estimate the individual probability of spontaneous conversion of https://doi.org/10.1016/j.ejim.2020.07.022 patients presenting with symptomatic atrial fibrillation, however, is not available.…”

Revisiting Antiarrhythmic Drug Therapy for Atrial Fibrillation: Reviewing Lessons Learned and Redefining Therapeutic Paradigms

“…While there was just under half a million of AF-related hospitalizations in the United States in 2010 (Patel et al, 2014), this number has been increasing with each subsequent year (Nisar et al, 2016). AF treatment costs $26 billion annually in the United States alone (Kim et al, 2011;Rozen et al, 2018) and this financial burden will continue to rise as AF soars to epidemic proportions.…”

“…In the United States, extended longevity from medical advances has led to the projection of up to 15 million patients diagnosed with AF by 2050 ( Miyasaka et al, 2006 ; Colilla et al, 2013 ). Modifiable risk factors for developing AF within 10 years ( Schnabel et al, 2009 ) include hypertension, diabetes mellitus ( Patel et al, 2014 ), coronary artery disease ( Peigh et al, 2020 ), heart failure, obesity ( Thacker et al, 2013 ), and obstructive sleep apnea ( Youssef et al, 2018 ). Non-modifiable AF risk factors include valvular heart disease ( Banerjee et al, 2019 ), hypertrophic cardiomyopathy ( Olivotto et al, 2001 ), and congenital heart disease ( Hu and Lin, 2019 ).…”

Metformin Use is Associated with A Lower Incidence of Hospitalization for Atrial Fibrillation in Patients with Type 2 Diabetes Mellitus

“…A recent study conducted in the USA showed an increasing trend of emergency department visits and hospitalization for AF (HAF) from 2007 to 2014 in a nationwide level and called for a "need for widespread implementation of effective strategies aimed at improving the management of patients with AF to reduce hospital admissions and the economic burden of AF" [15]. Because metformin is considered the rst-line antidiabetic drug for patients with type 2 diabetes mellitus, whether the use of metformin can prevent the potentially fatal disease of AF in these high-risk diabetes patients is of immense clinical importance.…”