title: Postoperative atrial fibrillation impacts on costs and one-year clinical outcomes: the Veterans Affairs Randomized On/Off Bypass Trial.
abstract: BACKGROUND
  New-onset postoperative atrial fibrillation (POAF) after coronary artery bypass graft surgery (CABG) is associated with worse in-hospital morbidity and mortality, extended hospital stays, and higher costs. Beyond the initial hospital discharge, the cost and outcomes of POAF have not been well studied.
  
  
  METHODS
  For CABG patients with and without new-onset POAF, a retrospective propensity-matched, multivariable regression analysis was performed to compare 1-year outcomes (including health-related quality of life [HRQoL] scores and mortality rates) and costs (standardized to 2010 dollars). Regression models controlled for site and patient factors, with propensity matching used to adjust for differences in POAF versus no-POAF patients' risk profiles.
  
  
  RESULTS
  Using the existing CABG trial database, 2,096 patient records were analyzed, including POAF patients (n = 549) versus no-POAF patients (n = 1,547). For the index CABG hospitalization, POAF patients had longer postoperative length of stay (+3.9 days) and higher discharge costs (+$13,993) than no-POAF patients. At 1 year, POAF patients had more than twice the adjusted odds of dying (p < 0.01), with higher 1-year total cumulative costs. This 1-year cost difference (+$15,593) was largely attributable to hospital-based costs during the index surgery hospitalization. There was no difference in 1-year HRQoL scores (or HRQoL score changes) between POAF patients and no-POAF patients.
  
  
  CONCLUSIONS
  Compared with no-POAF patients, POAF patients had higher discharge and 1-year costs along with higher 1-year mortality rates, but no differences were observed in 1-year HRQoL scores. Additional research appears warranted to improve the longer-term survival rates for POAF CABG patients, targeting future POAF-specific postdischarge interventions.
authors.affiliation: Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin; Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: halmassi@mcw.edu.
authors.forename: G Hossein
authors.initials: GH
authors.lastname: Almassi
authors.affiliation: Veterans Affairs Palo Alto Health Economics Resource Center, Menlo Park, California; Department of Health Research and Policy, Stanford University, Stanford, California.
authors.forename: Todd H
authors.initials: TH
authors.lastname: Wagner
authors.affiliation: Northport Veterans Affair Medical Center, Northport, New York.
authors.forename: Brendan
authors.initials: B
authors.lastname: Carr
authors.affiliation: Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado; University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Brack
authors.initials: B
authors.lastname: Hattler
authors.affiliation: Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Maryland.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Collins
authors.affiliation: VA Boston Healthcare System, West Roxbury, Massachusetts.
authors.forename: Jacquelyn A
authors.initials: JA
authors.lastname: Quin
authors.affiliation: Greater Los Angeles VA Medical Center, Los Angeles, California.
authors.forename: Ramin
authors.initials: R
authors.lastname: Ebrahimi
authors.affiliation: Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado; University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Grover
authors.affiliation: Northport Veterans Affair Medical Center, Northport, New York.
authors.forename: Muath
authors.initials: M
authors.lastname: Bishawi
authors.affiliation: Northport Veterans Affair Medical Center, Northport, New York; Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado.
authors.forename: A Laurie W
authors.initials: AL
authors.lastname: Shroyer
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000191:economics* / Q000453:epidemiology*; D001026:Coronary Artery Bypass; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics* / Q000453:epidemiology*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014728:Veterans