Hospital visits for atrial fibrillation rising


Hospital visits for atrial fibrillation are escalating, increasing the burden on the US healthcare system. An 11-year study, published in the American Heart Association journal Circulation, shows that hospitalisations for the condition jumped by 23% and costs rose by 24%. The rise in atrial fibrillation’s accompanying risk factors might account in part for the rise in hospitalisations.

Researchers, analysing data from almost four million hospitalisations for atrial fibrillation in 2001- 2010, found:

• In-hospital deaths declined, but hospitalisations increased by 23%, especially in people over age 65.
• The number of days people were hospitalised did not change. But after adjusting for inflation, the average cost of hospitalisation rose from US$6,410 to US$8,439 – a 24% increase.
• More women were hospitalised, but the difference between men is narrowing.
• Hospitals in the south USA had the highest percentage of atrial fibrillation hospitalisations (38%) while those in the west USA had the lowest (14%).
• High blood pressure was a coexisting condition about 60% of the time.
• Diabetes and lung disease were each coexisting conditions about 20% of the time.
• Rates of kidney failure as a coexisting condition increased four-fold since 2000 and reached 12.3% by 2010.
• In-hospital death rate was highest among those with heart failure (8.2%) or older than 80 (about 2%).

“Atrial fibrillation is a disease in itself, but it also serves as a marker for the severity of other illnesses,” says Nileshkumar Patel, lead author and internal medicine physician at Staten Island University Hospital, New York, USA.

“The hike in hospitalisations is probably because we are living longer and accompanying risk factors such as high blood pressure, obesity, sleep apnoea and diabetes are increasing,” he says. “Generally, the more secondary conditions people had, the longer their hospital stay and the higher their cost.”

Researchers analysed results from the Nationwide Inpatient Sample, the largest in-patient hospital database in the United States. The Agency for Healthcare Research and Quality collected the information from more than 1,200 hospitals across 45 states. The records yielded a cross-section of 3.96 million hospitalisations where atrial fibrillation was the primary diagnosis at discharge.

“We must treat atrial fibrillation and its risk factors better in the outpatient setting to prevent hospitalisations and reduce its staggering impact,” says Abhishek Deshmukh, a study author and a cardiologist at the University of Arkansas for Medical Sciences in Little Rock, USA.