J Cardiovasc Nurs. 2021;36(4):E29-E37. doi: 10.1097/JCN.0000000000000805.
The aim of this study was to assess healthcare utilization costs of a dedicated outpatient clinic for patients with atrial fibrillation (AF).
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.
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.
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.
本研究旨在评估专为心房颤动 (AF) 患者设立的门诊诊所的医疗保健利用成本。
我们进行了一项基于登记的回顾性研究，纳入了 2009 年至 2011 年（对照组）和 2013 年至 2015 年（干预组）首次诊断为 AF 的患者。对照组接受了以医生为主导的常规护理，而干预组则接受了多学科护理。主要结局是 AF 相关资源利用的总费用。探索性结局是缺血性卒中、颅内出血和全因死亡率。采用多元回归方法控制评估结果的混杂因素。
共纳入 1552 例患者，其中干预组 850 例。对照组的 AF 相关总费用为 2746 欧元，干预组为 3154 欧元，差异无统计学意义。对照组的平均门诊费用明显高于干预组（分别为 522 欧元和 344 欧元；P =.003）。对照组和干预组的 AF 相关住院和门诊就诊次数无差异（发生率风险比分别为 1.03 和 0.85；95%置信区间分别为 0.92-1.16 和 0.69-1.05）。干预组全因死亡率呈下降趋势（风险比为 0.86；95%置信区间为 0.63-1.16），但差异无统计学意义。
干预组 AF 相关住院资源利用总费用较高，但 AF 相关门诊就诊费用明显较低。干预组全因死亡率呈下降趋势，尽管差异无统计学意义。需要进一步研究多学科 AF 诊所是否具有成本效益。
