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Incidence and prevalence of atrial fibrillation and associated mortality among Medicare beneficiaries, 1993-2007.

ABSTRACT: Atrial fibrillation (AF) is a common and costly problem among older persons. The frequency of AF increases with age, but representative national data about incidence and prevalence are limited. We examined the annual incidence, prevalence, and mortality associated with AF among older persons.In a retrospective cohort study of Medicare beneficiaries 65 years and older diagnosed with AF between 1993 and 2007, we measured annual age- and sex-adjusted incidence and prevalence of AF and mortality following an AF diagnosis. Among 433,123 patients with incident AF, the mean age was 80 years, 55% were women, and 92% were white. The incidence of AF remained steady during the 14-year study period, ranging from 27.3 to 28.3 per 1000 person-years. Incidence rates were consistently higher among men and white beneficiaries. The prevalence of AF increased across the study period (mean, 5% per year) and was robust to sensitivity analyses. Among beneficiaries with incident AF in 2007, 36% had heart failure, 84% had hypertension, 30% had cerebrovascular disease, and 8% had dementia. Mortality after AF diagnosis declined slightly over time but remained high. In 2007, the age- and sex-adjusted mortality rates were 11% at 30 days and 25% at 1 year.Among older Medicare beneficiaries, incident AF is common and has remained relatively stable for more than a decade. Incident AF is associated with significant comorbidity and mortality; death occurs in one-quarter of beneficiaries within 1 year.

SUBMITTER: Piccini JP

PROVIDER: S-EPMC3332107 | biostudies-other | 2012 Jan

REPOSITORIES: biostudies-other

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Incidence and prevalence of atrial fibrillation and associated mortality among Medicare beneficiaries, 1993-2007.

Piccini Jonathan P JP Hammill Bradley G BG Sinner Moritz F MF Jensen Paul N PN Hernandez Adrian F AF Heckbert Susan R SR Benjamin Emelia J EJ Curtis Lesley H LH

Circulation. Cardiovascular quality and outcomes 20120110 1

<h4>Background</h4>Atrial fibrillation (AF) is a common and costly problem among older persons. The frequency of AF increases with age, but representative national data about incidence and prevalence are limited. We examined the annual incidence, prevalence, and mortality associated with AF among older persons.<h4>Methods and results</h4>In a retrospective cohort study of Medicare beneficiaries 65 years and older diagnosed with AF between 1993 and 2007, we measured annual age- and sex-adjusted i ...[more]

PMID: 22235070

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Project description:Background:Atrial fibrillation is increasingly prevalent as the US population ages and is associated with significant morbidity and mortality. Care for patients with atrial fibrillation can be costly, US health care costs are comparatively high, and there are few cost estimates available that incorporate detailed measurement of comorbidities and their effects on costs. Methods and Results:In the Cardiovascular Health Study and the Framingham Heart Study, participants aged 65?years or older with newly diagnosed atrial fibrillation were matched on age and follow-up time to referents free of atrial fibrillation. The total clinical and hospital medical costs paid by Medicare Parts A and B (drug costs from Medicare Part D costs were not included) in the year prior to diagnosis (or matching) were compared with costs in the following year. Estimates were adjusted for other medical conditions and adjusted to 2009 dollars. In the Cardiovascular Health Study, 513 participants were diagnosed with new-onset atrial fibrillation and survived 30?days post-atrial fibrillation diagnosis, and 513 referents (as a control cohort) were identified, with a mean age of 77?years. In the Framingham Heart Study, we identified 336 participants diagnosed with atrial fibrillation, who survived 30?days post-atrial fibrillation diagnosis and matched these participants to 336 referents. We compared these new-onset atrial fibrillation participants with referents, using a difference in difference design to account for both time trends and differences between the two groups. The adjusted incremental cost for participants with atrial fibrillation, compared with referents, was US$18,060 (95% confidence interval: US$14,965-US$21,155) in the Cardiovascular Health Study and US$20,012 (95% confidence interval: US$15,057-US$24,966) in the Framingham Heart Study. The pooled estimate was US$18,601 (95% confidence interval: US$15,981-US$21,234). Conclusion:Atrial fibrillation was associated with increased costs in the year after diagnosis in two community-based cohorts, even after careful accounting for age, time period, and systematically measured comorbidities.

Dataset Information

Incidence and prevalence of atrial fibrillation and associated mortality among Medicare beneficiaries, 1993-2007.

Publications

Incidence and prevalence of atrial fibrillation and associated mortality among Medicare beneficiaries, 1993-2007.

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