Skip to main content
SpringerLink
Log in

Resource Utilization and Outcomes in Patients with Atrial Fibrillation

A Case Control Study

  • Original Research Article
  • Published:
Applied Health Economics and Health Policy Aims and scope Submit manuscript

Abstract

Background: Atrial fibrillation (AF) is the most common sustained disorder of cardiac rhythm. Various new anticoagulation and antiarrythmic treatments are being investigated for the treatment of AF. Before novel treatments can be used widely in actual clinical practice, the cost effectiveness of such novel treatments may need to be determined.

Objective: The objectives of the study were to describe resource utilization for AF and control patients, and estimate the incidence of mortality.

Methods: This case control study evaluated 6 months of primary and secondary care resource utilization and mortality rates for patients within the period 01 April 2001 to 31 March 2006. Cases included 15 373 adults with a record of AF in the General Practice Research Database (GPRD) within the study period. The index date was randomly selected between 6 months after the AF record and end of data collection. Cases were matched to controls by age, gender, general practice and time.

Results: AF patients had significantly higher resource utilization than controls. Resource utilization increased with greater National Institute for Clinical Excellence (NICE) stroke risk strata (graded as low, moderate or high based on associated risk factors). Both current warfarin and aspirin users had higher resource utilization than control patients. Resource utilization remained high amongst AF patients who discontinued therapy. The mortality rate was significantly higher in AF patients than controls, deaths due to circulatory system disease were increased 4-fold and cancer deaths were doubled. All-cause and circulatory mortality rates, as well as rates of clinical outcomes, were related to the NICE stroke risk schema.

Conclusions: There was large heterogeneity in resource utilization between AF patients, although overall, this was still higher than controls without AF. Higher resource utilization was evident in patients at higher risk of stroke, and remained where antithrombotic therapy was discontinued. The mortality risk in AF was increased substantially, both for cardiovascular and non-cardiovascular causes of death, indicating a large unmet medical need.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II
Table III
Table IV
Table V
Table VI

Similar content being viewed by others

References

  1. Lip GY, Tse HF. Management of atrial fibrillation. Lancet 2007; 370:604–18

    Article  PubMed  Google Scholar 

  2. National Collaborating Centre for Chronic Conditions. Atrial fibrillation: national clinical guideline for management in primary and secondary care. London: Royal College of Physicians, 2006

    Google Scholar 

  3. Claxton K, Sculpher M, Drummond M. A rational framework for decision making by the National Institute for Clinical Excellence (NICE). Lancet 2002; 360: 711–5

    Article  PubMed  Google Scholar 

  4. Rawlins MD, Culyer AJ. National Institute for Clinical Excellence and its value judgments. BMJ 2004; 329: 224–7

    Article  PubMed  Google Scholar 

  5. National Institute for Clinical Excellence. Guidance for manufacturers and sponsors [online]. Available from URL: http://www.nice.org.uk/niceMedia/pdf/technicalguidanceformanufacturersandsponsors.pdf [Accessed 2008 Feb 11]

  6. Drummond MF, Jefferson TO. Guidelines for authors and peer reviewers of economic submissions to the BMJ. The BMJ Economic Evaluation Working Party. BMJ 1996; 313(7052): 275–83

    Article  PubMed  CAS  Google Scholar 

  7. O’Brien CL, Gage BF. Costs and effectiveness of ximelagatran for stroke prophylaxis in chronic atrial fibrillation. JAMA 2005; 293: 699–706

    Article  PubMed  Google Scholar 

  8. Eckman MH, Levine HJ, Salem DN, et al. Making decisions about antithrombotic therapy in heart disease: decision analytic and cost-effectiveness issues. Chest 1998; 114(5 Suppl.):699S–714S

    Article  PubMed  CAS  Google Scholar 

  9. Gage BF, Cardinalli AB, Albers GW, et al. Cost-effectiveness of warfarin and aspirin for prophylaxis of stroke in patients with nonvalvular atrial fibrillation. JAMA 1995; 274: 1839–45

    Article  PubMed  CAS  Google Scholar 

  10. Gage BF, Cardinalli AB, Owens DK. Cost-effectiveness of preference-based antithrombotic therapy for patients with nonvalvular atrial fibrillation. Stroke 1998; 29: 1083–91

    Article  PubMed  CAS  Google Scholar 

  11. Gustafsson C, Asplund K, Britton M, et al. Cost effectiveness of primary stroke prevention in atrial fibrillation: Swedish national perspective. BMJ 1992; 305: 1457–60

    Article  PubMed  CAS  Google Scholar 

  12. Sorensen SV, Dewilde S, Singer DE, et al. Cost-effectiveness of warfarin: trial versus “real-world” stroke prevention in atrial fibrillation. Am Heart J 2009; 157(6): 1064–73

    Article  PubMed  Google Scholar 

  13. van Staa TP, Leufkens HG, Zhang B, et al. A comparison of cost effectiveness using data from randomized trials or actual clinical practice: selective cox-2 inhibitors as an example. PLoS Med 2009 Dec; 6(12): e1000194

    Article  PubMed  Google Scholar 

  14. Parkinson J, Davis S, van Staa TP. The General Practice Research (GPRD) Database: now and the future. In: Mann R, editor. Pharmacovigilance 2007. London: Wiley-Blackwell, 2007

    Google Scholar 

  15. Stewart S, Murphy N, Walker A, et al. Cost of an emerging epidemic: an economic analysis of atrial fibrillation in the UK. Heart 2004; 90: 286–92

    Article  PubMed  CAS  Google Scholar 

  16. Coyne KS, Paramore C, Grandy S, et al. Assessing the direct costs of treating nonvalvular atrial fibrillation in the United States. Value Health 2006; 9: 348–56

    Article  PubMed  Google Scholar 

  17. Wolf PA, Mitchell JB, Baker CS, et al. Impact of atrial fibrillation on mortality, stroke, and medical costs. Arch Intern Med 1998; 158(3): 229–34

    Article  PubMed  CAS  Google Scholar 

  18. Bruggenjurgen B, Rossnagel Roll S, et al. The impact of atrial fibrillation on the cost of stroke: the Berlin acute stroke study. Value Health 2007; 10(2): 137–43

    Article  PubMed  Google Scholar 

  19. Reynolds MR, Essebag V, Zimetbaum P, et al. Healthcare resource utilization and costs associated with recurrent episodes of atrial fibrillation: the FRACTAL registry. J Cardiovasc Electrophysiol 2007; 18(6): 628–33

    Article  PubMed  Google Scholar 

  20. Le Heuzey J-Y, Paziaud O, Piot O, et al. Cost of care distribution in atrial fibrillation patients: the COCAF study. Am Heart J 2004; 147(1): 121–6

    Article  PubMed  Google Scholar 

  21. Ohsawa M, Okayama A, Okamura T, et al. Mortality risk attributable to atrial fibrillation in middle-aged and elderly people in the Japanese general population: nineteen-year follow-up in NIPPON DATA80. Circ J 2007; 71: 814–9

    Article  PubMed  Google Scholar 

  22. Rietbrock S, Heeley E, Plumb J, et al. Chronic atrial fibrillation: incidence, prevalence, and prediction of stroke using the congestive heart failure, hypertension, age >75, diabetes mellitus, and prior stroke or transient ischemic attack (CHADS2) risk stratification scheme. Am Heart J 2008; 156(1): 57–64

    Article  PubMed  Google Scholar 

  23. Flegel KM, Shipley MJ, Rose G. Risk of stroke in non-rheumatic atrial fibrillation. Lancet 1987; 1: 526–9

    Article  PubMed  CAS  Google Scholar 

  24. Wolf PA, Dawber TR, Thomas HE, et al. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study. Neurology 1978; 28: 973–7

    Article  PubMed  CAS  Google Scholar 

  25. Krahn AD, Manfreda J, Tate RB, et al. The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study. Am J Med 1995 May; 98(5): 476–84

    Article  PubMed  CAS  Google Scholar 

  26. Friberg L, Hammar N, Pettersson H, et al. Increased mortality in paroxysmal atrial fibrillation: report from the Stockholm Cohort-Study of Atrial Fibrillation (SCAF). Eur Heart J 2007; 28(19): 2346–53

    Article  PubMed  Google Scholar 

  27. Lainscak M, Dagres N, Filippatos GS, et al. Atrial fibrillation in chronic non-cardiac disease: where do we stand? Int J Cardiol 2008; 128(3): 311–5

    Article  PubMed  Google Scholar 

  28. Ruigómez A, Johansson S, Wallander M-A, et al. Incidence of chronic atrial fibrillation in general practice and its treatment pattern. J Clin Epidemiol 2002; 55: 358–63

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by Bayer, employees of whom were involved in the design of the study, interpretation of the data and review of the manuscript.

GPRD is owned by the UK Department of Health and operates within the Medicines and Healthcare products Regulatory Agency (MHRA). The views expressed in this paper are those of the authors and do not reflect the official policy or position of the MHRA, UK. GPRD is funded by the MHRA, Medical Research Council, various universities, contract research organizations and pharmaceutical companies. The Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences has received unrestricted funding for pharmacoepidemiological research from GlaxoSmithKline, Novo Nordisk, the private-public funded Top Institute Pharma (www.tipharma.nl, includes co-funding from universities, government, and industry), the Dutch Medicines Evaluation Board, and the Dutch Ministry of Health.

Dr Lip has served as a consultant for Bayer, Astellas, Merck, AstraZeneca, Sanofi, BMS/Pfizer, Biotronik, Portola, Boehringer Ingelheim and Sanofi-Aventis.

Author information

Authors and Affiliations

  1. Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, 151 Buckingham Palace Road, Victoria, London, SW1W 9SZ, UK

    Rachael Boggon, Arlene M. Gallagher &  Tjeerd P. van Staa

  2. University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK

    Gregory Y. H. Lip

  3. Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands

    Arlene M. Gallagher &  Tjeerd P. van Staa

Authors
  1. Rachael Boggon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gregory Y. H. Lip
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Arlene M. Gallagher
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tjeerd P. van Staa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tjeerd P. van Staa.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Boggon, R., Lip, G.Y.H., Gallagher, A.M. et al. Resource Utilization and Outcomes in Patients with Atrial Fibrillation. Appl Health Econ Health Policy 10, 249–259 (2012). https://doi.org/10.2165/11599940-000000000-00000

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/11599940-000000000-00000

Keywords

Search

Navigation