Medical Device Daily Washington Editor
NEW ORLEANS – In addition to breakthrough scientific data, organizers of this year’s Heart Rhythm Society (HRS; Washington) scientific sessions said there needs to be an increased focus on the financial side of heart rhythm management (Medical Device Daily, May 4, 2005).
As the most common heart rhythm disturbance, atrial fibrillation (AF) – given its financial impact on the healthcare system – is a pretty good place to start that greater examination.
During last week’s conference at the Ernest N. Morial Convention Center, Peter Zimetbaum, MD, assistant professor of medicine at Beth Israel Deaconess Medical Center and Harvard Medical School (Boston), presented information on the large socioeconomic implications of the disease.
“I think trying to get a clear sense for the cost of the management of atrial fibrillation is an incredibly difficult task,” Zimetbaum said, because the condition is interwoven with so many others ailments. “The rise in rates of atrial fibrillation of course is going to lead to a significant increase in healthcare expenditures,” he said
But Zimetbaum said that the rise in spending could be somewhat curbed – if not drastically reduced – through implementation of better disease management and reduction of hospital admissions, especially given the fact that most people deal with AF for 10 to 15 years.
Most of the costs come from the routine management of AF, he said, while costs from related complications, such as stroke, are harder to measure.
AF can cause blood to pool inside the heart and form clots, which leads to stroke. According to the American Heart As-sociation (Dallas), AF is the cause of 10% to 15% of all strokes.
Despite the increased availability of anti-arrhythmic drugs, the rate of hospital admissions for AF has increased over the last 10 years, Zimetbaum said.
When AF is examined as the principal discharge diagnosis, the total cost is about $2.7 billion per year in the U.S. And when it is measured as a co-morbid diagnosis, the cost is $1.8 billion, which Zimetbaum termed most likely an “underestimate.” The cost of AF on an outpatient basis also is roughly $1.8 billion.
Compared to other cardiovascular disorders, the numbers are low, according to Zimetbaum. But when cost implications are examined in the light of AF as a cause of other cardiovascular conditions, the impact is greater.
In the case of stroke, he said there is little information on the cost of AF’s impact. In the U.S., an estimated $51 billion in productivity is lost as a result of strokes. And nursing home costs produce another $12 billion in expenses, much of that related directly to AF. Emergency department visits in this country are a primary source of AF-related hospital admissions, and AF accounts for more than 50% of all arrhythmia-related hospital admissions, he said.
Through doctor and patient education efforts, Zimetbaum said his institution has been trying to create ways to make AF “an entirely outpatient disorder.”
“Interestingly, there is a bit of disparity in the U.S. with regard to hospital admissions and discharges related to atrial fibrillation, with lower admissions on the West Coast, where there is greater managed care, compared to the East Coast,” he said.
Efforts are leading to the implementation of more precise guidelines for AF discharge, he said.
Beth Israel estimates, Zimetbaum said, that “a simple, more common-sense approach in the emergency department” could reduce admissions to the hospital by 150,000 to 200,000 annually and save up to $500 million.
“Improved measure to education physicians and patients will improve the compliance with anticoagulation guidelines,” he said. “Tremendous resources are being devoted for a potential cure, but efforts need to be made to improve the safety and efficiency of the every day routine management of these patients.”