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Cost Analysis of a Dedicated Outpatient Clinic in Patients With Newly Diagnosed Atrial Fibrillation. J Cardiovasc Nurs 2021; 36:E29-E37. [PMID: 33783372 DOI: 10.1097/jcn.0000000000000805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS The aim of this study was to assess healthcare utilization costs of a dedicated outpatient clinic for patients with atrial fibrillation (AF). METHODS We conducted a registry-based retrospective study in patients with a first-time AF diagnosis from 2009 to 2011 (control group) and 2013 to 2015 (intervention group). The control group had physician-led usual care, and the intervention group received multidisciplinary care. The primary outcome was total costs of AF-related resource utilization. Exploratory outcomes were ischemic stroke, intracranial hemorrhage, and all-cause mortality. Multiple regression methods were used to control for confounders in the assessment of effects on outcomes. RESULTS A total of 1552 patients were included, hereof 850 in the intervention group. Total AF-related costs were €2746 for the control group and €3154 for the intervention group, which was not statistically significant. Average outpatient costs were significantly higher in the control group than in the intervention group (€522 vs €344, respectively; P = .003). There was no difference in the number of AF-related hospital admissions and outpatient visits between the control group and the intervention group (incidence risk ratio, 1.03 vs 0.85; and 95% confidence interval, 0.92-1.16 vs 0.69-1.05, respectively). There was a trend toward reduced all-cause mortality (hazard ratio, 0.86; 95% confidence interval, 0.63-1.16) in the intervention group, which was not statistically significant. CONCLUSION Total expenses for AF-related hospital resource utilization in the intervention group were higher, but the expenses for AF-related outpatient visits were significantly lower. There was a trend toward lower all-cause mortality in the intervention group, although the differences were not statistically significant. More research is needed investigating whether a multidisciplinary AF clinic is cost-effective.
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Wong JA, Quinn FR, Gillis AM, Burland L, Chen G, Wyse DG, Wilton SB. Temporal Patterns and Predictors of Rate vs Rhythm Control in Patients Attending a Multidisciplinary Atrial Fibrillation Clinic. Can J Cardiol 2016; 32:1247.e7-1247.e13. [PMID: 26992570 DOI: 10.1016/j.cjca.2016.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/19/2015] [Accepted: 01/05/2016] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Contemporary trends in the selection of and persistence with rate vs rhythm control for atrial fibrillation (AF) are not well studied, particularly in the context of multidisciplinary AF clinics. METHODS The initial arrhythmia management strategy in 1031 consecutive patients attending a multidisciplinary AF clinic from 2005-2012 was analyzed. RESULTS The 397 (38.5%) patients initially treated with rhythm control were younger (57.4 ± 14 years vs 65.6 ± 13 years; P < 0.0001) and more likely to be men (64.5% vs 56.9%; P = 0.019). They also had fewer comorbidities, lower CHADS2 (Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient Ischemic Attack) scores, and greater symptom burden. The proportion treated with rhythm control declined from 46.9% in 2005-2006 to 28.4% in 2012 (P for trend < 0.0001). Compared with those initially selecting rate control, patients treated with rhythm control required more frequent clinic encounters (7 [interquartile range {IQR}, 3-12] vs 3 [IQR, 2-7]; P < 0.001) and longer follow-up (266 days [IQR, 84-548 days] vs 99 days [IQR, 0-313 days]; P < 0.001). Younger age, absence of diabetes and sleep apnea, earlier treatment year, higher symptom burden, and rural residence were independently associated with rhythm control. Persistence with the initial treatment strategy was reduced in the rhythm-control group (P = 0.003). CONCLUSIONS Use of rhythm control as the initial arrhythmia management strategy for AF in a specialty AF clinic is declining. Rhythm control requires more intensive follow-up and was more likely to lead to a change in arrhythmia management strategy.
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Affiliation(s)
- Jorge A Wong
- Cardiac Arrhythmia Service, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cuming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - F Russell Quinn
- Cardiac Arrhythmia Service, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cuming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Anne M Gillis
- Cardiac Arrhythmia Service, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cuming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Laurie Burland
- Cardiac Arrhythmia Service, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cuming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Guanmin Chen
- Cardiac Arrhythmia Service, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cuming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - D George Wyse
- Cardiac Arrhythmia Service, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cuming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stephen B Wilton
- Cardiac Arrhythmia Service, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cuming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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