National Trends in Atrial Fibrillation Hospitalization, Mortality

Study Questions:

What has been the national trend in outcomes of atrial fibrillation (AF) hospitalizations?

Methods:

The data in this study were obtained from a Medicare database of >68 million beneficiaries >65 years old. Patients with a primary discharge diagnosis of AF or flutter in 1999-2013 were identified. The primary outcomes of the study were annual AF hospitalizations, mortality, and 30-day readmission rates.

Results:

The rate of AF hospitalization increased from 668/100,000 person-years in 1999 to 700/100,000 person-years in 2013. The rate of AF catheter ablation increased from 0.4% in 1999-2000 to 2.1% in 2013. In-hospital mortality decreased significantly from 1.6% in 1999 to 1.3% in 2013. After adjustment for demographic variables and comorbidities, there was an annual reduction in the 30-day mortality rate of 0.4% and in the 1-year mortality rate of 0.26%. After adjustment for demographic variables and comorbidities, the 30-day readmission rate decreased by 0.96%/year. Between 1999 and 2013, the median length-of-stay for an AF hospitalization remained stable at 3 days, but the mean Medicare expenditure/patient increased from $2,932 to $4,719.

Conclusions:

Outcomes including in-hospital-, 30-day, and 1-year mortality have improved on an annual basis between 1999 and 2013 among Medicare beneficiaries.

Perspective:

The rise in AF hospitalizations between 1999 and 2013 can be explained by the progressive increase in the age-adjusted incidence of AF documented in prior studies. The reasons for the improved outcomes in this study are unknown, but may include the more widespread use of catheter ablation, more judicious use of antiarrhythmic drugs, improvements in device therapy, the advent of novel oral anticoagulants, and improvements in sleep apnea therapies.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Sleep Apnea

Keywords: Anti-Arrhythmia Agents, Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Atrial Flutter, Catheter Ablation, Geriatrics, Health Expenditures, Hospital Mortality, Medicare, Patient Readmission, Secondary Prevention, Sleep Apnea Syndromes


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