Abstract 10686: Atrial Fibrillation and Heart Failure Increase Length of Hospital Stay, Total Healthcare Utilization, and Costs in Acute Coronary Syndromes
Introduction: The impact of concomitant atrial fibrillation (AF) and heart failure (HF) among patients with acute coronary syndromes (ACS) on healthcare utilization and costs has not been well defined. We assessed the risk of hospitalization, medical utilization and incremental healthcare costs in newly-diagnosed ACS patients with concomitant AF, HF, and both AF+HF.
Methods: Medical and pharmacy claims from 2007-2010 were analyzed using IMS LifeLink data. Patients were divided into 4 cohorts: ACS only (reference cohort), ACS + AF, ACS +HF, ACS+HF+AF. ACS-related healthcare costs were reported in 2011 dollars using Tobit regression models adjusting for age, gender, region, medical coverage, and chronic condition index. A negative binominal regression model was used to determine the incidence rate ratio (IRR) for ACS-related healthcare utilization adjusting for the same covariates.
Results: We identified 21,530 patients with ACS. Of these, 3,698 had ACS + HF; 2,009 had ACS + AF, and 1,866 had ACS+ AF +HF. Of all patients, 58-64% were male and more than two-thirds were commercially insured (66-78%). The mean age was 59.8±12.94 years for patients with ACS only, 69.3±12.6 years for ACS +AF, 67.0±14.3 years for ACS+HF, and 74.7±12.55 years for ACS+HF+AF. Compared to the reference cohort (ACS only), the adjusted ACS-related annual healthcare costs per patient were incrementally higher for ACS+AF at $5,662 (95% CI $4,752-6,574); ACS+HF at $8,123 (95% CI $7,421-8,826); and ACS+HF+AF at $16,218 (95% CI $15,235-17,201). The Table summarizes the IRR for adjusted ACS-related healthcare utilization.
Conclusion: Our data suggest that concomitant AF, HF, and AF+HF significantly increase the economic burden among newly diagnosed ACS patients, with a 2-4 fold increase in ACS related hospitalizations and a 2-6 fold increase in the average length of stay. Harmonization of evidenced-based cardiovascular-specific treatment guidelines may be needed in order to address this issue.
- © 2013 by American Heart Association, Inc.