title: Identifying predictors of cumulative healthcare costs in incident atrial fibrillation: a population-based study.
abstract: BACKGROUND
  Atrial fibrillation (AF) has substantial impacts on healthcare resource utilization. Our objective was to understand the pattern and predictors of cumulative healthcare costs in AF patients after incident diagnosis in an emergency department (ED).
  
  
  RESULTS
  Patients discharged after a first presentation of AF to an ED in Ontario, Canada, were identified from April 1, 2005, through March 31, 2010. Per-patient cumulative healthcare costs were determined until death or March 31, 2012. Join-point analyses identified clinically relevant cost phases. Hierarchical generalized linear models with a logarithmic link and gamma distribution determined predictors of cost per phase. Our cohort was 17 980 patients. During a mean follow-up of 3.9 years, 17.1% of patients died. Three distinct cost phases were identified: 2-month post-index ED visit phase, 12-month predeath phase, and a stable/chronic phase. The mean cost per patient in the first month post-index ED visit was $1876 (95% CI $1822 to $1931), $8050 (95% CI $7666 to $8434) in the month before death, and $640 (95% CI $624 to $655) per month for the stable/chronic phase. The main cost component in the post-index phase was physician services (32% of all costs) and hospitalizations for the predeath phase (72% of all costs). The CHA2DS2-VASc clinical risk score was a strong predictor of costs (rate ratio 1.91 and 5.08 for score of 7 versus score of 0 in predeath phase and postindex phase, respectively).
  
  
  CONCLUSIONS
  There are distinct phases of resource utilization in AF, with highest costs in the predeath phase.
authors.affiliation: Division of Cardiology, Schulich Heart Centre and Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (M.C.B., D.T.K., S.M.S., H.C.W.).
authors.forename: Maria C
authors.initials: MC
authors.lastname: Bennell
authors.affiliation: Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada (F.Q., D.T.K., H.C.W.).
authors.forename: Feng
authors.initials: F
authors.lastname: Qiu
authors.affiliation: Faculty of Medicine, University of Ottawa, Ontario, Canada (A.M.).
authors.forename: Andrew
authors.initials: A
authors.lastname: Micieli
authors.affiliation: Division of Cardiology, Schulich Heart Centre and Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (M.C.B., D.T.K., S.M.S., H.C.W.) Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada (F.Q., D.T.K., H.C.W.) Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada (D.T.K., P.D., H.C.W.).
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Ko
authors.affiliation: Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada (D.T.K., P.D., H.C.W.) Division of Cardiology and Department of Medicine, St Michael's Hospital, University of Toronto, Ontario, Canada (P.D.).
authors.forename: Paul
authors.initials: P
authors.lastname: Dorian
authors.affiliation: Trauma, Emergency and Critical Care Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada (C.L.A.) Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (C.L.A., H.C.W.).
authors.forename: Clare L
authors.initials: CL
authors.lastname: Atzema
authors.affiliation: Division of Cardiology, Schulich Heart Centre and Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (M.C.B., D.T.K., S.M.S., H.C.W.).
authors.forename: Sheldon M
authors.initials: SM
authors.lastname: Singh
authors.affiliation: Division of Cardiology, Schulich Heart Centre and Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (M.C.B., D.T.K., S.M.S., H.C.W.) Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada (F.Q., D.T.K., H.C.W.) Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada (D.T.K., P.D., H.C.W.) Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (C.L.A., H.C.W.).
authors.forename: Harindra C
authors.initials: HC
authors.lastname: Wijeysundera
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000191:economics*; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology
keywords: arrhythmia; atrial flutter; cost‐benefit analysis; fibrillation