What's in store for the $26B AF burden?

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Kaitlyn Dmyterko, senior writer

It is no surprise that atrial fibrillation (AF), the most common cardiac arrhythmia, soaks up $26 billion U.S. dollars per year. And researchers from Northwestern University in Chicago, speculate that this figure will double within the next 25 years as the population continues to age.

However, a study this week showed that a growing number of healthy, middle-aged women may be developing new-onsets of AF, which could put them at an increased risk of death and cardiovascular events. Of the 34,722 women within the Women’s Health Study, 1,011 women developed a new-onset of AF and 64.9 percent of these patients were classified as paroxysmal.

However, an accompanying JAMA editorial argued that the women within the Women's Health Study may not have been as “healthy” as reported. In fact, Yoko Miyasaka, MD, PhD, and Teresa S.M.Tsang , MD, of the Kansai Medical University in Hirakata, Japan, and University of British Columbia in Vancouver wrote that while the population of women was free of cardiovascular disease at baseline, half of the women who developed AF had hypertension and a third had hypercholesterolemia.

Additionally, Miyasaka and Tsang said that when compared with women who remained free of AF; those who had AF were more likely to have hypertension, diabetes, hypercholesterolemia, smoke and high body mass indexes. Therefore, these women were at a heightened risk and Miyasaka and Tsang questioned whether these women can be considered “healthy.”

Now, in addition to the AF burden for elderly, sicker patients, we must wonder whether efforts should focus on management and prevention strategies for younger, middle-aged patients at lower risk. Earlier this month at the annual HRS meeting, Alpesh N. Amin, MD, of the University of California, Irvine, and colleagues conducted two studies to better outline the cost burden associated with AF.

Amin and colleagues found that inpatient costs for AF or atrial flutter patients were significantly greater than for patients without these arrhythmias, a $5,694 cost difference. Outpatient and prescription costs were also much higher for atrial flutter or AF patients.

Patients with AF have higher readmission rates and incur higher overall healthcare costs compared with those without. How will we account for these high healthcare costs surrounding AF especially as the arrhythmias continue to be prevalent in younger, less sick patients? How can we optimally detect, treat and manage AF to further prevent additional CV events or death?

While newer, potentially safer, anticoagulants enter the market we wonder what the future of AF and its burden holds.

On these topics or others, please feel free to contact me.

Kaitlyn Dmyterko
Senior writer, Cardiovascular Business