Mechanisms for increased healthcare expenditures among patients with device detected atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Background There are limited data on the mechanisms of increased healthcare costs among patients with atrial fibrillation (AF). Differences in healthcare expenditures at various sites of service may provide mechanistic insight into the cost differentials between patients with and without AF. Objective To assess for associations between sites of service and healthcare costs among patients with and without device detected AF (ddAF). Methods Using the de-identified Optum® Clinformatics® U.S. claims database (2015 to 2020) linked with the Medtronic CareLink® database, we identified CIED patients that transmitted data ≥6 months post-implant (baseline period). Annualized per-patient costs during follow-up, subdivided by site of service, were compared between patients with and without ddAF and adjusted to 2020 US Dollars. Analyses were adjusted for geographical region, insurance type, CHA2DS2-VASc Score, and implant year. The ten most common hospitalization diagnosis-related groups (DRG) were analyzed in patients with and without ddAF. Results Of the 21,391 patients (72.9±10.9 yrs; 56.3% male) analyzed, 7,798 (36.5%) had ddAF. Compared to patients without ddAF, those with ddAF had higher annualized total healthcare costs (adjusted cost ratio (CR) 1.21 (1.16-1.25); p<0.001). There were no differences in clinic health expenditures between patients with and without ddAF (adjusted CR 1.01 (0.98-1.04); p=0.63). Patients with ddAF had higher inpatient hospitalization (adjusted CR 1.29 (1.21-1.37); p<0.001), outpatient hospitalization (adjusted CR 1.20 (1.15-1.24); p<0.001), long-term care facility (adjusted CR 1.39 (1.24-1.55); p<0.001), and total pharmacy (adjusted CR 1.14 (1.10-1.19); p<0.001) costs than patients without ddAF (fig). Heart failure hospitalizations accounted for the highest percentage of analyzed DRGs. Patients with and without ddAF had similar percentages of DRGs for heart failure hospitalization (ddAF: 41.9%; no ddAF: 41.3%). Of the hospitalization DRGs analyzed, 9.7% were for arrhythmia-related hospitalizations in the ddAF cohort. Conclusion Increased hospitalization, long term care facility, and pharmacy costs are largely responsible for the healthcare cost differential between patients with and without ddAF. It is likely that arrhythmia-related hospitalizations account for a significant portion of the increased cost associated with ddAF. Further research into specific interventions that occur at various sites of service, which produce increased cost among patients with ddAF, is needed.