Atrial fibrillation (AF) is the most common abnormal heart rhythm disorder encountered in practice and it is responsible for considerable healthcare use and costs. Studies have shown that females with AF experience more symptoms, more functional impairment, and are more likely to suffer from AF-related clinical consequences compared to males. However, how these sex differences impact the healthcare system is unclear. In a recent publication in CJC Open, researchers sought to determine if sex differences were present in high-cost user (HCU) AF patients, who account for the top 10% of total healthcare costs.
This population-based study included data from Alberta, Canada on all patients 20 years or older with an emergency department or hospitalization record for AF between 2011 and 2015. The researchers utilized the Canadian Institutes of Health Research (CIHI) “dynamic cohort of complex, high system users” to identify all HCUs in the patient population. The study defined healthcare utilization as hospital, emergency department, and physician office visits during the study period, and costs included anything related to hospitalization, ambulatory care, drugs, and physician billing. Additionally, all costs were adjusted to account for the inflation rate of the Canadian dollar in 2022.
The researchers found that nearly one-third of all AF patients are HCUs and accounted for two-thirds of total healthcare costs. Despite a lower number of females with AF, they represented an equal proportion of HCUs and almost half of total costs. According to lead author Dr. Roopinder Sandhu, “there are several possible reasons to explain these findings, including female AF patients are often older with more cardiac conditions leading to a higher burden of AF, they often have more symptoms prompting visits to the emergency department and admissions to the hospital, and symptomatic females are less likely to receive care aimed at controlling their rhythm.” Overall, the study findings suggest that enhanced strategies for the prevention and early treatment of AF HCUs are needed to help lessen the financial strain on the healthcare system.
This research was co-authored by the CVC’s Roopinder Sandhu, MD, MPH, Hena Qureshi, MSc, Doug Dover, PhD, Nathan Klassen, MA, and Padma Kaul, PhD, along with Heather Halperin, BSc and Nathaniel Hawkins, MD (University of Alberta), and Jason Andrade, MD (University of British Columbia).