Objectives: To provide a contemporary nationally representative assessment of atrial fibrillation (AF) and atrial flutter (AFL) expenditures in the United States.
Background: AF prevalence is rising over time and management is evolving. However, there has been no contemporary national assessment of expenditures of AF.
Methods: Using Medical Expenditure Panel Survey (MEPS) 2016-2021 data, we identified individuals with AF or AFL using International Classification of Disease (ICD)-10 codes and reported total and categorized expenditures. Using two-part and gamma regression models, respectively, we estimated the incremental expenditures with AF for the entire population and for individuals with common coexisting comorbidities. Among individuals with AF, we identified characteristics associated with higher expenditures.
Results: Of a weighted surveyed population of 248,067,064 adults, 3,564,763 (1.4%) had AF. Mean age was 71.9 ± 10.6 years and 45.7% were female. Mean unadjusted annual total healthcare expenditure for individuals with AF was $25,451 ± $1,100 compared with $9,254 ± $82 for individuals without AF. The highest spending categories were inpatient visits ($7,975 ± $733) and prescriptions ($6,505 ± $372). AF expenditures increased over the study period by 11.1%. After adjustment, the incremental annual expenditure attributable to AF was $6,188 per person. Incremental expenditures with AF were highest for those with cancer ($11,967, 95% CI $4,410 - $19,525), while AF did not significantly increase expenditures in HF (-$2,756, 95% CI -$10,048 - $4,535). Modified Charlson Comorbidity Index of 1 or ≥2, uninsured status, cancer, poor income level, ASCVD, COPD, and later survey year were associated with higher expenditures.
Conclusion: AF is associated with substantial healthcare expenditures which are increasing over time. With changes in screening and management, expenditures need periodic reassessments.