Abstract 15547: Impact of Atrial Fibrillation on Healthcare Costs After Myocardial Infarction - A Community Cohort Study
Background: Atrial fibrillation (AF) is frequent in myocardial infarction (MI), yet the incremental economic impact of AF, and the timing of its onset, on healthcare costs after MI is not known.
Methods: This cohort included incident MI patients from Olmsted County, MN between 11/1/2002 and 12/31/2010. We compared costs that accumulated between the incident MI and the end of follow-up (defined as earliest of the death date, last follow-up date, or study end date 09/30/2011) between three groups: no AF, new-onset AF (AF within 30 days after MI), and prior AF. Costs were standardized to Medicare-reimbursable rates, and inflation-adjusted to 2011. Patient characteristics and study outcomes were compared using Kruskal Wallis or Chi-squared tests. Multivariable-adjusted median costs accounted for right-censoring of costs.
Results: Of 1389 MI patients, 989 had no AF, 163 had new-onset AF, and 237 had prior AF with median follow-up of 3.98, 3.23 and 2.55 years, respectively. Mean patient age at index was 67 years, with younger patients (64 vs. 76 & 77, p<0.001), and higher proportion of males (62% vs. 49% & 50%, p<0.001) in the no-AF group than in new-onset and prior AF groups. The respective frequency of hypertension (64%, 77% & 85%, p<0.001), heart failure (8%, 12% & 43%, p<0.001) and COPD (12%, 19% & 33%, p<0.001) was higher for new and prior AF. After accounting for differences in age, sex, BMI, smoking status and comorbid conditions, the multivariable-adjusted median (95% CI) healthcare costs for MI patients were: $73K ($69K, $76K) for no AF group; $85K ($81K, $89K) for new-onset AF group; and $97K ($94K, $100K) for prior AF group. Inpatient costs comprised the largest share of total median costs (no AF=82%, new AF=84% and prior AF=83%). However, multivariable-adjusted lifetime median cost for patients who died (N=391) was not significantly different between new-onset AF ($86K, 95%CI: $74K, $98K) and prior AF ($87K, 95%CI: $78K, $95K) patients.
Conclusion: These community data indicate that AF frequently coexists with MI and imposes incremental costs, mainly inpatient care, to MI patients. While among all patients with MI and AF, those with prior AF have higher median cost than those developing new AF, the lifetime costs among patients who died did not differ by the timing of AF.
- © 2013 by American Heart Association, Inc.