Heart rhythm disorder 'major public health challenge and socioeconomic burden'

By American Heart Association News

Emergency department worker with heart monitor

Emergency room visits for atrial fibrillation are soaring. Added to the number of people admitted to the hospital for the condition, it’s contributing to “an alarming growth” in its economic burden to the country, according to a new study.

Annual visits to the emergency department for this heart rhythm disorder, often called AFib, increased by 30.7 percent from 2007 to 2014, or from 411,406 visits to 537,801, according to a study published Friday in the (link opens in new window)Journal of the American Heart Association.

During the same period, hospitalizations for the condition increased 15.7 percent, from 288,225 to 333,570.

The figures were drawn from a weighted analysis of 3.8 million visits to emergency departments nationwide specifically for atrial fibrillation. About two out of five patients visiting the hospital during the period analyzed in the study were age 75 or older. Women were slightly more likely to have the condition than men.

Atrial fibrillation is the most common type of arrhythmia, or irregular heartbeat, which can lead to blood clots, stroke, heart failure and other heart-related complications. At least 2.7 million – and possibly as many as 6.1 million – American adults are living with AFib.

The study, which described AFib as “a major public health challenge and socioeconomic burden,” found that hospital-related charges for patients admitted with AFib increased by 37 percent, from $7.39 billion in 2007 to $10.1 billion in 2014.

“The question we asked is, why are so many people being admitted for AFib, and are there strategies that could help patients avoid hospitalizations without compromising the quality of care or outcome in any way, and maybe even improve them,” said Dr. Jeremy Ruskin, the study’s senior author and founder and director emeritus of the Cardiac Arrhythmia Service at Massachusetts General Hospital.

“There are strategies we and others have implemented to manage a subset of stable, uncomplicated patients (with AFib) in the emergency department and avoid hospitalizations for many of them,” Ruskin said. “Patients who are unstable and have complications such as congestive heart failure will continue to require hospital admission.”

Many of the patients who sought treatment for atrial fibrillation also had other chronic health problems, including high blood pressure, congestive heart failure, diabetes and kidney disease. Ruskin said those conditions are commonly associated with AFib and tend to be predictors of admission.

“It’s understandable that the sicker patients with more of these concomitant medical problems are likely to be admitted,” said Ruskin, a professor of medicine at Harvard Medical School.

But he also pointed out that the study found hospitalization rates for AFib in the United States were nearly twice as high as those seen in Canada and Europe.

“We also know from experience in other countries and some of our own initiatives that a sizable percentage of patients who come to the emergency room can be managed with medications and can then be discharged from the emergency room and managed safely on an outpatient basis,” he said.

Dr. Lin Yee Chen, an associate professor of medicine at the University of Minnesota Medical School and an atrial fibrillation researcher who was not involved in the study, said the findings confirm what many in the field have suspected about AFib’s growing economic burden. The study is important in putting firm figures behind it, he said.

“We know that there’s increasing incidence and prevalence of atrial fibrillation. Part of this can be explained by the growing aging population. It’s a contributor to chronic diseases in general and definitely to AFib,” said Chen, who chaired the writing committee for an American Heart Association scientific statement on atrial fibrillation.

More work needs to be done to intervene before the patient ends up in the hospital, with strategies to manage AFib, Chen said, much the way doctors are now trying to do with congestive heart failure.

“There’s a big push toward improving management of heart failure in the outpatient setting so that it will reduce ER visits and hospitalizations, which are not only expensive but also bad for the patient,” he said. “Likewise, for AFib. We need to try to improve or optimize management in the outpatient setting so that we can reduce flare-ups or exacerbations that will result in visiting the ER and hospitalizations.”

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