Elsevier

American Heart Journal

Volume 147, Issue 1, January 2004, Pages 121-126
American Heart Journal

Clinical investigation
Cost of care distribution in atrial fibrillation patients: the COCAF study

https://doi.org/10.1016/S0002-8703(03)00524-6Get rights and content

Abstract

Background

Atrial fibrillation (AF) currently represents a major economic burden for society. Very few studies have been performed to evaluate the cost of care for AF patients. This study is a large prospective survey designed to analyze the different cost drivers in the treatment of these patients. This survey, named Cost of Care in Atrial Fibrillation (COCAF), evaluated the cost of care for patients with AF treated by cardiologists in general office practice.

Methods

A group of 671 patients was recruited by 82 cardiologists distributed in all regions of France. The mean age of the patients was 69 years, and 64% were male. The mean follow-up was 329 ± 120 days. The costs of care were analyzed from the health care payer and the societal perspectives.

Results

During the follow-up period, 21 patients (3.13%) died and 210 (31.3%) patients were hospitalized. The number of hospitalizations and deaths was significantly higher in the group of persistent or permanent AF (PEAF) patients, as compared to paroxysmal AF (PAAF) patients. Hospitalizations were much more frequent in the PEAF group (127) than in the PAAF group (83, P < .05). Deaths were also much more frequent in the PEAF group (17) as compared to the PAAF group (4, P < .001). From the societal perspective, the first cost driver was hospitalizations (52%), followed by drugs (23%), consultations (9%), further investigations (8%), loss of work (6%), and paramedical procedures (2%). In multivariate analysis the following parameters were significantly associated with higher costs: heart failure (P < .04), coronary artery disease (P < .001), use of class III antiarrhythmic drugs (P < .002), hypertension (P < .002) and metabolic disease (P < .001).

Conclusions

This prospective survey shows that hospitalizations represent the major cost driver in the treatment of AF patients. Outpatient care programs must be proposed to AF patients in order to avoid readmissions and to reduce the cost of treatment.

Section snippets

Population

A group of 671 patients with AF were recruited during 1 year by 82 cardiologists distributed in all regions of France. They were consecutive patients seen by these cardiologists, without particular inclusion or exclusion criteria and regardless of the duration of AF. The cardiologists were randomly selected, and the number of cardiologists recruited in a given region was weighted by the number of inhabitants. The number of recruited patients was limited to 12 per cardiologist.

Among these

Clinical characteristics of the patients

The mean blood pressure of these patients was 139/81, their mean heart rate was 67 bpm. In patients with PAAF, the mean heart rate was 71 bpm in sinus rhythm (86 bpm during AF episodes). In the PEAF group, the mean heart rate was higher: 80 bpm in AF.

A large majority of these patients (78% with PAAF and 84% with PEAF) were suffering from concomitant diseases at inclusion: hypertension in 43% of patients, heart failure in 16%, coronary artery disease in 13%, and valvular heart disease in 13%.

Discussion

The main finding of this large survey is that hospitalizations represent the major cost driver in cost of care for AF patients. The population we have studied is very close to that of the Etude en Activité Libeiale de la Fibrillation Auriculaire (ALFA) study.6 It demonstrates a shift toward nonrheumatic AF. Underlying heart disease was present in a large proportion of patients (78% in PAAF and 84% in PEAF). Hypertension was the most common underlying condition (43%). This high proportion is

Acknowledgements

We thank E. Tarral, C. Durieux, P. Ngo, and the 82 cardiologists who have participated to the study for their help.

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