New Report Demonstrates Medicare's Burden from Use of Health Services Among Atrial Fibrillation Patients

WASHINGTON, Sept. 22 /PRNewswire/ -- Medicare patients with atrial fibrillation (AFib) require a broad, expensive and recurring array of health services, according to a new report released today by Avalere Health(1).  The results foreshadow an increasing cost burden to the Medicare system related to AFib, despite its low profile among other chronic diseases, and an aging generation nearing the most at-risk years for the disease(2).

The report, "Health Services Utilization and Medical Costs Among Medicare Atrial Fibrillation Patients," was written by Avalere Health and funded as an outcome of AF Stat™: A Call to Action for Atrial Fibrillation, a collaboration of healthcare leaders and organizations working to improve the health and well-being of people affected by AFib.  AF Stat is an initiative sponsored by sanofi-aventis U.S. LLC.  It is the third report in a series that representatives of AF Stat are commissioning to better illustrate the burden of this chronic disease.

Characterized by an irregular and frequently fast heartbeat, AFib is the most common form of heart arrhythmia. It affects approximately 2.5 million Americans, and its prevalence is expected to increase as the U.S. population ages(3).  AFib is associated with a five-fold increase in risk for stroke(4); worsens underlying cardiovascular disease(5); and doubles the risk of all-cause mortality(6).

The report shows that total medical costs of treating AFib averaged almost $24,000 per beneficiary, with 62 percent of these costs attributable to inpatient care(7).  By way of comparison, this is on par with other cardiovascular conditions recognized as cost drivers, including treatment for acute coronary syndrome, myocardial infarction and unstable angina(8), according to separate research cited by the authors.

"As policymakers work to implement healthcare reform, it is critical to evaluate how different chronic diseases impact Medicare and the healthcare system overall," said Senator Bill Frist, M.D., former Senate Majority Leader and health policy advisor for AF Stat. "This report sheds important new light on the AFib patient's experience – how many health services they require, the costs associated with that care, and the opportunities to improve AFib management for better quality and efficiency in healthcare delivery."

According to the report, Medicare serves as the primary payer for AFib across all settings of care, including hospital inpatient and outpatient visits, physician office visits, and emergency care(9).  The use of such a broad array of health services leads Medicare to pay an estimated $15.7 billion each year to treat newly-diagnosed AFib patients(10).  This is largely due to the later onset of AFib, which predominantly affects people over the age of 65(11),and the number of age-related comorbidities associated with AFib(12).

The report further illustrates that Medicare is impacted by a particularly high usage of healthcare services among Medicare AFib patients:

• Patients saw physicians an average of 67 times during the 15-month follow-up period(13).  
• During this same follow-up period, 61 percent of patients needed emergency services at least once, averaging three trips per patient(14).
• Medicare AFib patients generally experience extended and repeated stays in the hospital: During their initial hospitalization for AFib, on average patients stayed in the hospital for four days, costing nearly $5,500 per patient(15).
• Among those who were readmitted to the hospital after their initial stay, half experienced one rehospitalization, and 24 percent were readmitted twice(16). Nearly half of these readmissions took place within six months of the first trip to the hospital(17).

"Clearly, medical professionals, the Medicare system, and AFib patients all struggle to manage this complex disease," said Senator Frist.  "This translates into high costs and a significant human toll.  This is why the numerous organizations participating in AF Stat are working together to elevate AFib on the public health agenda, as well as to develop new tools and approaches that can enhance the delivery of quality care for patients."

The full report is available at www.AFStat.com.

Methodology

Avalere Health conducted a retrospective database analysis based on Medicare's five percent Standard Analytic Files (SAFs) for 2004-2008.  The study population included patients with a primary diagnosis of AFib during an 'initial' or 'index' hospitalization, with a requirement that patients have at least nine consecutive quarters of Medicare enrollment (four quarters preceding and four quarters following the quarter of index hospitalization).  For AFib patients in the study, Avalere examined the utilization of, and costs associated with, hospital inpatient and outpatient services, physician services, and emergency department services, tracking the utilization and costs of these services during the follow-up period (defined as the quarter of the index hospitalization and the four subsequent quarters).  Medicare payments are used as a proxy for medical costs; all costs are reported as 2007 US dollars.  

About the AF Stat Report Series

The AF Stat Report Series is designed to better illustrate the burden of atrial fibrillation, and to address the four priority areas recommended by the AF Stat Call to Action document: policy and advocacy, management, education and quality.  Reports in this series include Medicare and Atrial Fibrillation: Consequences in Cost and Care, written by Avalere Health; and The Impact of Atrial Fibrillation on Quality of Life, by Paul Dorian, M.D.

The third report in this series, Health Services Utilization and Medical Costs Among Medicare Atrial Fibrillation Patients, was written by Avalere Health and funded by sanofi-aventis U.S. LLC, which is the sponsor for AF Stat.  Avalere maintained editorial control and the conclusions expressed in the report are those of the author.

About AF Stat™: A Call to Action for Atrial Fibrillation

AF Stat is a collaboration of healthcare leaders and organizations working to improve the health and well-being of people affected by atrial fibrillation.  AF Stat is raising awareness of AFib as a complex, costly, progressive and often debilitating disease.  It also is calling for and helping promote a change in attitudes and behaviors to enhance AFib understanding, diagnosis and management.  AF Stat is an initiative sponsored by sanofi-aventis U.S. LLC. More information can be found at www.AFStat.com

AF Stat is an initiative sponsored by sanofi-aventis U.S. LLC, which also funded the Health Services Utilization and Medical Costs Among Medicare Atrial Fibrillation Patients report.

(1) Sullivan, E., et al., "Health Services Utilization and Medical Costs Among Medicare Atrial Fibrillation Patients." Avalere Health. 2010:4:11-13.

(2) Sullivan, E., et al., "Health Services Utilization and Medical Costs Among Medicare Atrial Fibrillation Patients." Avalere Health. 2010:4:15-18.

(3) Go AS. "Prevelance of Atrial Fibrillation in Adults: National Implications for Rhythm Management and Stroke Prevention: The Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study." Journal of American Medical Association.  May 9, 2001-Vol 285, No. 18.

(4) Wolf PA, Abbott RD, Kannel, WB. Atrial fibrillation as an independent risk factor for stroke:

the Framingham Study. Stroke. 1991;22;983-988.  

(5) Fuster V, Ryden LE, Cannom DS, et al.ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006;114:e257-e354.

(6) Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation. 1998;98:946-952.

(7) Sullivan, E., et al., "Health Services Utilization and Medical Costs Among Medicare Atrial Fibrillation Patients."  Avalere Health. 2010:2:11-12.

(8) Etemad LR, McCollam PL.  "Total First Year Costs of Acute Coronary Syndrome in a Managed Care Setting." J Manag Care Pharm. May 2005.11. 302.6/2.1-3.

(9) Sullivan, E., et al., "Health Services Utilization and Medical Costs Among Medicare Atrial Fibrillation Patients."  Avalere Health. 2010:8:Figure 2.

(10) Lee W. Lamas G. Balu S., et al. "Direct treatment cost of atrial fibrillation in the elderly American population: a Medicare perspective." Journal of Medical Economics. 2008. 11. 285.1/ 2. 1-2. AND 283. 1/1. 1-6. AND 293. 1/ 2. 11-13. AND 287. 1/ 2. 6-10.

(11) Go A. Hylek E. Phillips K., et al. "Factors in Atrial Fibrillation(ATRIA) Study Stroke Prevention: The Anticoagulation and Risk National Implications for Rhythm Management and Prevalence of Diagnosed Atrial Fibrillation in Adults." JAMA, 2001: 285(18):2370-2375.

(12) Fuster, V., et al., "ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation-executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation)." Eur Heart J. 2006. 27.1993.6/2.1-3.

(13) Sullivan, E., et al., "Health Services Utilization and Medical Costs Among Medicare Atrial Fibrillation Patients."  Avalere Health. 2010:3:3

(14) Sullivan, E., et al., "Health Services Utilization and Medical Costs Among Medicare Atrial Fibrillation Patients."  Avalere Health. 2010:3: 16-18

(15) Sullivan, E., et al., "Health Services Utilization and Medical Costs Among Medicare Atrial Fibrillation Patients."  Avalere Health. 2010:15:Table 4.

(16) Sullivan, E., et al., "Health Services Utilization and Medical Costs Among Medicare Atrial Fibrillation Patients."  Avalere Health. 2010:19:Table 7.

(17) Sullivan, E., et al., "Health Services Utilization and Medical Costs Among Medicare Atrial Fibrillation Patients."  Avalere Health. 2010:18:Figure 8.

SOURCE AF Stat