Economic Burden and Disparities in Healthcare Resource Use Among Adult Patients with Cardiac Arrhythmia
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As of 2012, approximately 4.3 million Americans experience some form of cardiac arrhythmia (CA). Assessment of economic burden and healthcare resource use on the overall CA population is limited.
To assess healthcare expenditure and disparities in healthcare resource use in patients with all forms of CA in the US.
Data from the Medical Expenditure Panel Survey were analyzed between 2004 and 2009. Patients aged ≥18 years with any form of CA (identified via International Classification of Disorders Ninth Revision, Clinical Modification [ICD-9-CM] codes) were included. Primary independent variables included age, gender, race/ethnicity, and pharmacotherapy use. Outcomes of interest included total annual healthcare and prescription expenditures (inflation adjusted to 2011), use of anti-arrhythmic agents associated with CA, and inpatient, outpatient, or emergency room visits. Generalized linear models were used to assess the disparities across patient subgroups related to the outcomes.
Annually, 5,750,440 individuals experienced CA in the US. Total direct annual healthcare cost of CA summed up to $US67.4 billion. Non-Hispanic whites and older adult patients had higher expenditures and use of healthcare resources (p < 0.05). Female patients had significantly higher prescribed medication expenditures and a lower proportion of inpatient and emergency room visits related to arrhythmia (p < 0.05). Patients taking anti-arrhythmic agents had significantly higher expenditure and a lower proportion of emergency department visits related to arrhythmia (p < 0.05).
CA represents a substantial economic burden in the US, especially for the older adult population. Patients other than non-Hispanic whites may not have adequate access to healthcare treatment for arrhythmia.
- American Heart Association. 2012. http://www.heart.org/HEARTORG/. Accessed 8 February 2012.
- Heart disease and stroke statistics-2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 119: pp. e21-e181 CrossRef
- Coyne, KS, Paramore, C, Grandy, S (2006) Assessing the direct costs of treating nonvalvular atrial fibrillation in the United States. Value Health 9: pp. 348-356 CrossRef
- Rich, MW (2009) Epidemiology of atrial fibrillation. J Interv Card Electrophysiol 25: pp. 3-8 CrossRef
- Go, AS, Hylek, EM, Phillips, KA (2001) Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. J Am Med Assoc 285: pp. 2370-2375 CrossRef
- Miyasaka, Y, Barnes, ME, Gersh, BJ (2006) Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation 114: pp. 119-125 CrossRef
- Borzecki, AM, Bridgers, DK, Liebschutz, JM (2008) Racial differences in the prevalence of atrial fibrillation among males. J Natl Med Assoc 100: pp. 237-245
- Orejarena, LA, Vidaillet, H, DeStefano, F (1998) Paroxysmal supraventricular tachycardia in the general population. J Am Coll Cardiol 31: pp. 150-157 CrossRef
- Benjamin, EJ, Levy, D, Vaziri, SM (1994) Independent risk factors for atrial fibrillation in a population-based cohort: the Framingham Heart Study. J Am Med Assoc 271: pp. 840-844 CrossRef
- American College of Cardiology; American Heart Association Task Force; European Society of Cardiology Committee for Practice. Guidelines for the management of patients with supraventricular arrhythmias: 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 develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society. J Am Coll Cardiol. 2003;42:1493–1531.
- American College of Cardiology; American Heart Association Task Force; European Society of Cardiology Committee for Practice Guidelines; European Heart Rhythm Association; Heart Rhythm Society. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: 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.
- American College of Cardiology; American Heart Association Task Force; European Society of Cardiology Committee for Practice Guidelines; European Heart Rhythm Association; Heart Rhythm Society. ACC/AHA/ESC 2006 guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: 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 Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006;114:e385–e484.
- Task Force of the Working Group on Arrhythmias of the European Society of Cardiology. The Sicilian Gambit: a new approach to the classification of antiarrhythmic drugs based on their actions of arrhythmogenic mechanisms. Circulation. 1991;84:1831–1851.
- Rohrbacker, NJ, Kleinman, NL, White, SA (2010) The burden of atrial fibrillation and other cardiac arrhythmias in an employed population: associated costs, absences, and objective productivity loss. J Occup Environ Med 52: pp. 383-391 CrossRef
- Heuzey, JY, Paziaud, O, Piot, O (2004) Cost of care distribution in atrial fibrillation patients: the COCAF study. Am Heart J 147: pp. 121-126 CrossRef
- Reynolds, MR, Essebag, V, Zimetbaum, P (2007) Healthcare resource utilization and costs associated with recurrent episodes of atrial fibrillation: the FRACTAL registry. J Cardiovasc Electrophysiol 18: pp. 628-633 CrossRef
- Dorian, P, Paquette, M, Newman, D (2002) Quality of life improves with treatment in the Canadian Trial of Atrial Fibrillation. Am Heart J 143: pp. 984-990 CrossRef
- Lönnerholm, S, Blomström, P, Nilsson, L (2000) Effects of the maze operation on health-related quality of life in patients with atrial fibrillation. Circulation 101: pp. 2607-2611 CrossRef
- Pappone, C, Rosanio, S, Augello, G (2003) Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: outcomes from a controlled nonrandomized long-term study. J Am Coll Cardiol 42: pp. 185-197 CrossRef
- Singh, BN, Singh, SN, Reda, DJ (2005) Amiodarone versus sotalol for atrial fibrillation. N Engl J Med 352: pp. 1861-1872 CrossRef
- Schulman, KA, Berlin, JA, Harless, W (1999) The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med 340: pp. 618-626 CrossRef
- Peterson, ED, Shaw, LK, DeLong, ER (1997) Racial variation in the use of coronary-revascularization procedures, are the differences real? Do they matter?. N Engl J Med 336: pp. 480-486 CrossRef
- Poon, I, Lal, LS, Ford, ME (2009) Racial/ethnic disparities in medication use among veterans with hypertension and dementia: a national cohort study. Ann Pharmacother 43: pp. 185-193
- Zucerman, IH, Ryder, PT, Simoni-Wastila, L (2008) Racial and ethnic disparities in the treatment of dementia among Medicare beneficiaries. J Gerontol Ser B Psychol Sci Soc Sci 63: pp. S328-S333 CrossRef
- Briesacher, B, Limcangco, R, Gaskin, D (2003) Racial and ethnic disparities in prescription coverage and medication use. Health Care Financ Rev 25: pp. 63-76
- Gaskin, DJ, Briesacher, B, Limcango, R (2006) Exploring racial and ethnic disparities in prescription drug spending and use among Medicare beneficiaries. Am J Geriatr Pharmacother 4: pp. 96-111 CrossRef
- Cohen, JW, Cohen, SB, Banthin, JS (2009) The medical expenditure panel survey: a national information resource to support healthcare cost research and inform policy and practice. Med Care 47: pp. S44-S50 CrossRef
- MEPS-HC Sample Design and Collection Process. Agency for Healthcare Research and Quality, Rockville, MD. http://www.meps.ahrq.gov/survey_comp/hc_data_collection.jsp. Accessed 4 April 2012.
- Chisholm, MA, Wells, BG, Schwinghammer, TL eds. (2007) Pharmacotherapy principles and practice. McGraw Hill Medical, New York
- D’Hoore, W, Bouckaert, A, Tilquin, C (1996) Practical considerations on the use of the Charlson Comorbidity Index with administrative databases. J Clin Epidemiol 49: pp. 1429-1433 CrossRef
- Schonlau M. Stata software package, hotdeckvar.pkg, for hotdeck imputation. 2006. Accessed 4 April 2012. http://www.schonlau.net/stata/.
- Sarto, GE (2004) The gender gap: new challenges in women’s health. Sex Reprod Menopause 2: pp. 9-14 CrossRef
- Michelena, HI, Powell, BD, Brady, PA (2010) Gender in atrial fibrillation: ten years later. Gend Med 7: pp. 206-217 CrossRef
- Essebag, V, Hadjis, T, Platt, RW (2003) Amiodarone and the risk of bradyarrhythmia requiring permanent pacemaker in elderly patients with atrial fibrillation and prior to myocardial infarction. J Am Coll Cardiol 41: pp. 249-254 CrossRef
- Census Bureau (US), Population Division. Population estimates: race/ethnicity. 2003. Retrieved 04/04/12 from http://eire.census.gov/popest/data/race.php.
- Department of Health and Human Services (US) and Health Resources and Services Administration (US). Health care rx: access for all. Barriers to health care for racial and ethnic minorities: access, workforce diversity and cultural competence. Boston, MA. 1998.
- Healthy People 2010 Final Review-Complete Report. http://www.cdc.gov/nchs/data/hpdata2010/hp2010_final_review.pdf. Accessed 1 October 2013.
- Koh, HK (2010) A 2020 vision for healthy people. N Engl J Med 362: pp. 1653-1656 CrossRef
- Khairallah, F, Ezzedine, R, Ganz, LL (2004) Epidemiology and determinants of outcome of admissions for atrial fibrillation in the United States from 1996 to 2001. Am J Cardiol 94: pp. 500-504 CrossRef
- Song, Y, Skinner, J, Bynum, J, Sutherland, J, Wennberg, JE, Fisher, ES (2010) Regional variations in diagnostic practices. New Engl J Med 363: pp. 45-53 CrossRef
- Luft, HS (2012) From small area variations to accountable care organizations: how health services research can inform policy. Ann Rev Public Health 33: pp. 377-382 CrossRef
- McMahon, LF, Wolfe, RA, Tedeschi, PJ (1989) Variation in hospital admissions among small areas: a comparison of Maine and Michigan. Med Care 27: pp. 623-631 CrossRef
- Welch, HG, Sharp, SM, Gottlieb, DJ (2011) Geographic variation in diagnosis frequency and risk of death among Medicare beneficiaries. J Am Med Assoc 305: pp. 1113-1118 CrossRef
- Economic Burden and Disparities in Healthcare Resource Use Among Adult Patients with Cardiac Arrhythmia
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