Skip to main content
PMC home page
Clinical Cardiology logoLink to Clinical Cardiology
. 2010 May 20;33(5):270–279. doi: 10.1002/clc.20759

Cost Burden of Cardiovascular Hospitalization and Mortality in ATHENA‐Like Patients With Atrial Fibrillation/Atrial Flutter in the United States

Gerald V Naccarelli 1,✉, Stephen S Johnston 2, Jay Lin 3, Parag P Patel 1, Kathy L Schulman 2
PMCID: PMC6652891  PMID: 20513065

Abstract

Background

The ATHENA trial (A placebo‐controlled, double‐blind, parallel arm Trial to assess the efficacy of dronedarone 400 mg bid for the prevention of cardiovascular Hospitalization or death from any cause in patiENts with Atrial fibrillation/atrial flutter) demonstrated that dronedarone reduced the risk of cardiovascular (CV) hospitalization/death by 24% (P < 0.001) in patients with atrial fibrillation (AF) and atrial flutter (AFL).

Hypothesis

In order to estimate the cost savings associated with dronedarone use, we estimated the costs associated with CV hospitalizations and inpatient mortality in a large cohort of ATHENA‐like patients.

Methods

In this retrospective analysis, we evaluated the cost of CV hospitalization/mortality in real‐world ATHENA‐like patients without heart failure and with employer‐sponsored Medicare supplemental insurance in the United States. Patients similar to those in ATHENA (age ≥ 70 years with AF/AFL and ≥ 1 stroke risk factor, without heart failure) who were hospitalized between January 2, 2005, and January 1, 2007, were identified from the MarketScan databases from Thomson Reuters. Health care costs were evaluated during the 12 months following the index hospitalization.

Results

The analysis included 10 200 ATHENA‐like patients. Hospitalization for CV causes occurred in 53.9% of patients, with a total of 6700 CV hospitalizations for fatal/nonfatal causes. The most common nonfatal causes of CV hospitalizations were AF/other supraventricular rhythm disorders (20.2% of all CV hospitalizations), congestive heart failure (CHF; 14.3%), and transient ischemic attack (TIA)/stroke (10.7%). Mean costs per CV hospitalization for nonfatal causes were $10908. Inpatient deaths from CV causes occurred in 264 (2.6%) patients; the most common causes of CV inpatient death were intracranial/gastrointestinal hemorrhage (24.2% of CV deaths), TIA/stroke (17.0%), and CHF (15.9%). Mean hospitalization costs per CV inpatient death were $18 565.

Conclusions

Health care costs associated with CV hospitalizations and inpatient deaths among ATHENA‐like patients in the US are high. Novel antiarrhythmic therapies such as dronedarone, with the potential to reduce CV hospitalizations/mortality in similar patients, could decrease health care costs if adopted in clinical practice. Copyright © 2010 Wiley Periodicals, Inc.

Full Text

The Full Text of this article is available as a PDF (193.8 KB).

References

  • 1. Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 2001; 285: 2370–2375. [DOI] [PubMed] [Google Scholar]
  • 2. Naccarelli GV, Varker H, Lin J, et al. Increasing prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol 2009; 104: 1534–1539. [DOI] [PubMed] [Google Scholar]
  • 3. Miyasaka Y, Barnes ME, Gersh BJ, et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence [published correction appears in Circulation. 2006;114:e498]. Circulation 2006; 114: 119–125. [DOI] [PubMed] [Google Scholar]
  • 4. Miyasaka Y, Barnes ME, Gersh BJ, et al. Changing trends of hospital utilization in patients after their first episode of atrial fibrillation. Am J Cardiol 2008; 102: 568–572. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Atrial Fibrillation Investigators. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials [published correction appears in Arch Intern Med. 1994;154:2254]. Arch Intern Med 1994; 154: 1449–1457. [PubMed] [Google Scholar]
  • 6. Krahn AD, Manfreda J, Tate RB, et al. The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow‐Up Study. Am J Med 1995; 98: 476–484. [DOI] [PubMed] [Google Scholar]
  • 7. Stewart S, Hart CL, Hole DJ, et al. A population‐based study of the long‐term risks associated with atrial fibrillation: 20‐year follow‐up of the Renfrew/Paisley study. Am J Med 2002; 113: 359–364. [DOI] [PubMed] [Google Scholar]
  • 8. Halligan SC, Gersh BJ, Brown RD, Jr. , et al. The natural history of lone atrial flutter. Ann Intern Med 2004; 140: 265–268. [DOI] [PubMed] [Google Scholar]
  • 9. Biblo LA, Yuan Z, Quan KJ, et al. Risk of stroke in patients with atrial flutter. Am J Cardiol 2001; 87: 346–349, A9. [DOI] [PubMed] [Google Scholar]
  • 10. Reynolds MR, Essebag V, Zimetbaum P, et al. Health care resource utilization and costs associated with recurrent episodes of atrial fibrillation: the FRACTAL registry. J Cardiovasc Electrophysiol 2007; 18: 628–633. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11. Coyne KS, Paramore C, Grandy S, et al. Assessing the direct costs of treating nonvalvular atrial fibrillation in the United States. Value Health 2006; 9: 348–356. [DOI] [PubMed] [Google Scholar]
  • 12. Le Heuzey JY, Paziaud O, Piot O, et al. Cost of care distribution in atrial fibrillation patients: the COCAF study. Am Heart J 2004; 147: 121–126. [DOI] [PubMed] [Google Scholar]
  • 13. Fuster V, Rydén LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). J Am Coll Cardiol 2006; 48: 854–906. [DOI] [PubMed] [Google Scholar]
  • 14. Wattigney WA, Mensah GA, Croft JB. Increasing trends in hospitalization for atrial fibrillation in the United States, 1985 through 1999: implications for primary prevention. Circulation 2003; 108: 711–716. [DOI] [PubMed] [Google Scholar]
  • 15. Friberg J, Buch P, Scharling H, et al. Rising rates of hospital admissions for atrial fibrillation. Epidemiology 2003; 14: 666–672. [DOI] [PubMed] [Google Scholar]
  • 16. Hohnloser SH, Crijns HJ, van Eickels M, et al. Effect of dronedarone on cardiovascular events in atrial fibrillation. N Engl J Med 2009; 360: 668–678. [DOI] [PubMed] [Google Scholar]
  • 17. Ye X, Gross CR, Schommer J, et al. Initiation of statins after hospitalization for coronary heart disease. J Manag Care Pharm 2007; 13: 385–396. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18. Zhou F, Harpaz R, Jumaan AO, et al. Impact of varicella vaccination on health care utilization. JAMA 2005; 294: 797–802. [DOI] [PubMed] [Google Scholar]
  • 19. Hohnloser SH, Connolly SJ, Crijns HJ, et al. Rationale and design of ATHENA: A placebo‐controlled, double‐blind, parallel arm Trial to assess the efficacy of dronedarone 400 mg bid for the prevention of cardiovascular Hospitalization or death from any cause in patiENts with Atrial fibrillation/atrial flutter. J Cardiovasc Electrophysiol 2008; 19: 69–73. [DOI] [PubMed] [Google Scholar]
  • 20. Køber L, Torp‐Pedersen C, McMurray JJ, et al. Increased mortality after dronedarone therapy for severe heart failure. N Engl J Med 2008; 358: 2678–2687. [DOI] [PubMed] [Google Scholar]
  • 21. Tu JV, Zhang H. Congestive heart failure outcomes in Ontario In: Naylor CD, Slaughter PM, eds. Cardiovascular Health and Services in Ontario: An ICES Atlas. Toronto, Canada: Institute for Clinical Evaluative Sciences; 1999; 30–33. [Google Scholar]
  • 22. Lloyd‐Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics—2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009; 119:e21–e181. [DOI] [PubMed] [Google Scholar]
  • 23. Centers for Medicare & Medicaid Services, US Department of Health and Human Services . Health Care Financing Review: Medicare & Medicaid Statistical Supplement. Table 5.5: Discharges, total days of care, and program payments for Medicare beneficiaries discharged from short‐stay hospitals, by principal diagnoses with major diagnostic classifications (MDCs): calendar year 2006. Baltimore, MD: Centers for Medicare & Medicaid Services; 2006.
  • 24. Brüggenjürgen B, Rossnagel K, Roll S, et al. The impact of atrial fibrillation on the cost of stroke: the Berlin Acute Stroke Study. Value Health 2007; 10: 137–143. [DOI] [PubMed] [Google Scholar]
  • 25. Wolf PA, Mitchell JB, Baker CS, et al. Impact of atrial fibrillation on mortality, stroke, and medical costs. Arch Intern Med 1998; 158: 229–234. [DOI] [PubMed] [Google Scholar]
  • 26. Kim MH, Lin J, Hussein M, et al. How much does it cost to manage atrial fibrillation in the United States? Circ Cardiovasc Qual Outcomes 2009; 2:e1–e66. [Google Scholar]
  • 27. de Lissovoy G, Zodet M, Coyne K, et al. Treatment charges and resource use among patients with heart failure enrolled in an MCO. Manag Care Interface 2002; 15: 46–52. [PubMed] [Google Scholar]
  • 28. Claesson L, Gosman‐Hedström G, Johannesson M, et al. Resource utilization and costs of stroke unit care integrated in a care continuum: a 1‐year controlled, prospective, randomized study in elderly patients: the Göteborg 70+ Stroke Study. Stroke 2000; 31: 2569–2577. [DOI] [PubMed] [Google Scholar]
  • 29. Heller RF, Fisher JD, D'Este CA, et al. Death and readmission in the year after hospital admission with cardiovascular disease: the Hunter Area Heart and Stroke Register. Med J Aust 2000; 172: 261–265. [DOI] [PubMed] [Google Scholar]
  • 30. Johansen HL, Wielgosz AT, Nguyen K, et al. Incidence, comorbidity, case fatality and readmission of hospitalized stroke patients in Canada. Can J Cardiol 2006; 22: 65–71. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31. Aranda JM, Jr. , Johnson JW, Conti JB. Current trends in heart failure readmission rates: analysis of Medicare data. Clin Cardiol 2009; 32: 47–52. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32. Kim MH, Lin J, Hussein M, et al. Incidence and temporal pattern of hospital readmissions for patients with atrial fibrillation. Curr Med Res Opin 2009; 25: 1215–1220. [DOI] [PubMed] [Google Scholar]
  • 33. Humphries KH, Jackevicius C, Gong Y, et al. Population rates of hospitalization for atrial fibrillation/flutter in Canada. Can J Cardiol 2004; 20: 869–876. [PubMed] [Google Scholar]
  • 34. De Ferrari GM, Klersy C, Ferrero P, et al. Atrial fibrillation in heart failure patients: prevalence in daily practice and effect on the severity of symptoms. Data from the ALPHA study registry. Eur J Heart Fail 2007; 9: 502–509. [DOI] [PubMed] [Google Scholar]
  • 35. Wyse DG, Waldo AL, DiMarco JP, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002; 347: 1825–1833. [DOI] [PubMed] [Google Scholar]
  • 36. Corley SD, Epstein AE, DiMarco JP, et al. Relationships between sinus rhythm, treatment, and survival in the Atrial Fibrillation Follow‐Up Investigation of Rhythm Management (AFFIRM) Study. Circulation 2004; 109: 1509–1513. [DOI] [PubMed] [Google Scholar]
  • 37. Lafuente‐Lafuente C, Mouly S, Longás‐Tejero MA, et al. Antiarrhythmic drugs for maintaining sinus rhythm after cardioversion of atrial fibrillation: a systematic review of randomized controlled trials. Arch Intern Med 2006; 166: 719–728. [DOI] [PubMed] [Google Scholar]
  • 38. Wyse DG, Slee A, Epstein AE, et al. Alternative endpoints for mortality in studies of patients with atrial fibrillation: the AFFIRM study experience. Heart Rhythm 2004; 1: 531–537. [DOI] [PubMed] [Google Scholar]
  • 39. Slee A, Rathod S, Saksena S. Impact of a composite outcome analysis in evaluating atrial fibrillation treatment strategies: a current reassessment of the AFFIRM study. Circulation 2009; 120: S692 (abstract). [Google Scholar]
  • 40. Torp‐Pedersen C, Møller M, Bloch‐Thomsen PE, et al. Dofetilide in patients with congestive heart failure and left ventricular dysfunction. Danish Investigations of Arrhythmia and Mortality on Dofetilide Study Group. N Engl J Med 1999; 341: 857–865. [DOI] [PubMed] [Google Scholar]
  • 41. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373–383. [DOI] [PubMed] [Google Scholar]
  • 42. Von Korff M, Wagner EH, Saunders K. A chronic disease score from automated pharmacy data. J Clin Epidemiol 1992; 45: 197–203. [DOI] [PubMed] [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley

RESOURCES