Healthcare resource utilization and costs associated with recurrent episodes of atrial fibrillation: the FRACTAL registry.
BACKGROUND
Drivers of cost in the atrial fibrillation (AF) population are not fully understood. We sought to characterize the resource utilization and costs of treating new-onset AF, with emphasis on the incremental costs associated with recurrent episodes of AF over time.


RESULTS
An inception cohort of 973 AF patients was followed at 3-6 month intervals in an observational registry over a mean of 24 +/- 9 months. AF therapies, clinical outcomes, and both inpatient and outpatient medical resource utilization were tracked at each follow-up interval. Registry patients were managed primarily with cardioversion and pharmacological therapy. Direct healthcare costs were calculated from a U.S. perspective by multiplying measures of resource utilization by representative price weights. Costs were compared among patients in whom the initial episode of AF became permanent and patients who initially achieved sinus rhythm and had either 0, 1-2, or > or = 3 documented recurrences during follow-up. Mean annual costs for these four groups were $2,372, $3,385, $6,331, and $10,312 per patient per year, respectively (P < 0.001 for trend), with the largest variation related to hospital costs. In multivariable analysis controlling for demographic characteristics and baseline cardiac and comorbid conditions, each documented recurrence of AF was found to increase annual healthcare costs by approximately $1,600.


CONCLUSIONS
Following initial diagnosis, patients with AF treated with traditional therapies incur $4,000-$5,000 in annual direct healthcare costs. Costs are markedly higher in patients with multiple AF recurrences. These data may be helpful in evaluating the economic impact of new technologies for treating AF.
Reynolds
Matthew R
MR
Beth Israel Deaconess Medical Center, Division of Cardiology, Boston, MA 02215, USA. mreynold@bidmc.harvard.edu
Essebag
Vidal
V
Zimetbaum
Peter
P
Cohen
David J
DJ
D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D001281:Atrial Fibrillation / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D004358:Drug Therapy / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006295:Health Resources / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D012008:Recurrence; D012042:Registries; D012044:Regression Analysis; D014481:United States / Q000453:epidemiology