Borah Bijan J, Roger Véronique L, Mills Roger M, Weston Susan A, Anderson Stephanie S, Chamberlain Alanna M
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Clin Cardiol. 2015 Sep;38(9):548-54. doi: 10.1002/clc.22448. Epub 2015 Sep 7.
The authors sought to estimate incremental economic impact of atrial fibrillation (AF) and the timing of its onset in myocardial infarction (MI) patients.
Concurrent AF and its timing are associated with higher costs in MI patients.
This retrospective cohort study included incident MI patients from Olmsted County, Minnesota, treated between November 1, 2002, and December 31, 2010. We compared inflation-adjusted standardized costs accumulated between incident MI and end of follow-up among 3 groups by AF status and timing: no AF, new-onset AF (within 30 days after index MI), and prior AF. Multivariate adjustment of median costs accounted for right-censoring in costs.
The final study cohort had 1389 patients, with 989 in no AF, 163 in new-onset AF, and 237 in prior AF categories. Median follow-up times were 3.98, 3.23, and 2.55 years, respectively. Mean age at index was 67 years, with significantly younger patients in the no AF group (64 years vs 76 and 77 years, respectively; P < 0.001). New-onset and prior AF patients had more comorbid conditions (hypertension, heart failure, and chronic obstructive pulmonary disease). After accounting for differences in baseline characteristics, we found adjusted median (95% confidence interval) costs of $73 000 ($69 000-$76 000) for no AF; $85 000 ($81 000-$89 000) for new-onset AF; and $97 000 ($94 000-$100 000) for prior AF. Inpatient costs composed the largest share of total median costs (no AF, 82%; new-onset AF, 84%; prior AF, 83%).
Atrial fibrillation frequently coexists with MI and imposes incremental costs, mainly attributable to inpatient care. Timing of AF matters, as prior AF was found to be associated with higher costs than new-onset AF.
作者试图评估心房颤动（AF）的增量经济影响及其在心肌梗死（MI）患者中的发病时间。
MI患者中并发AF及其发病时间与更高的费用相关。
这项回顾性队列研究纳入了2002年11月1日至2010年12月31日期间在明尼苏达州奥尔姆斯特德县接受治疗的新发MI患者。我们根据AF状态和发病时间，比较了3组患者从新发MI到随访结束期间累积的经通胀调整的标准化费用：无AF、新发AF（在首次MI后30天内）和既往AF。对中位数费用进行多变量调整以考虑费用中的右删失情况。
最终研究队列有1389例患者，其中989例无AF，163例新发AF，237例既往AF。中位随访时间分别为3.98年、3.23年和2.55年。首次发病时的平均年龄为67岁，无AF组患者明显更年轻（分别为64岁，而其他两组为76岁和77岁；P<0.001）。新发AF和既往AF患者有更多的合并症（高血压、心力衰竭和慢性阻塞性肺疾病）。在考虑基线特征差异后，我们发现无AF患者调整后的中位数（95%置信区间）费用为73000美元（69000 - 76000美元）；新发AF患者为85000美元（81000 - 89000美元）；既往AF患者为97000美元（94000 - 100000美元）。住院费用在总中位数费用中占最大比例（无AF组为82%；新发AF组为84%；既往AF组为83%）。
心房颤动常与MI并存并带来增量费用，主要归因于住院治疗。AF的发病时间很重要，因为发现既往AF比新发AF与更高的费用相关。
