Institute of Population Health, University of Liverpool, UK.
Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
Eur Heart J Qual Care Clin Outcomes. 2024 Jun 20;10(4):326-333. doi: 10.1093/ehjqcco/qcad055.
Stroke prevention is central to the management of atrial fibrillation (AF), but there remains a residual risk of adverse outcomes in anticoagulated AF patients. Hence, current guidelines have proposed a more holistic or integrated approach to AF management, based on the Atrial fibrillation Better Care (ABC) pathway, as follows: (A) avoid stroke with anticoagulation; (B) better symptom control with patient-centred symptom directed decisions on rate or rhythm control; and (C) cardiovascular and comorbidity management, including lifestyle factors. There has been no formal healthcare cost analysis from the UK National Health Service (NHS) perspective of ABC pathway implementation to optimize the management of AF. Our aim was to estimate the number of patients with AF in the UK each year up to 2040, their morbidity and mortality, and the associated healthcare costs, and secondly, to estimate improvements in morbidity and mortality of implementing an ABC pathway, and the impact on costs.
In 2020, there were an estimated 1 463 538 AF patients, resulting in £286 million of stroke care and £191 million of care related to bleeds annually. By 2030, it is expected that there will be 2 115 332 AF patients, resulting in £666 million of stroke healthcare and £444 million of healthcare related to bleeds. By 2040, this is expected to rise to 2 856 489 AF patients, with £1096 million of stroke healthcare and £731 million of healthcare related to bleeds for that year. If in 2040 patients are managed on an ABC pathway, this could prevent between 3724 and 18 622 strokes and between 5378 and 26 890 bleeds, and save between 16 131 and 80 653 lives depending on the proportion of patients managed on the pathway. This would equate to cost reductions of between £143.9 million and £719.6 million for the year.
We estimate that there will be a substantial healthcare burden in the UK NHS associated with AF, from strokes, bleeds, and mortality over the next decades. If patients are managed with a holistic or integrated care approach based on the ABC pathway, this could prevent strokes and bleeds that equate to substantial NHS healthcare cost reductions, and save lives.
中风预防是心房颤动（AF）管理的核心，但接受抗凝治疗的 AF 患者仍存在不良结局的残余风险。因此，目前的指南基于心房颤动更好的护理（ABC）途径，提出了一种更全面或综合的 AF 管理方法，如下所示：（A）通过抗凝预防中风；（B）根据患者为中心的症状，针对节律或心率控制做出决策，更好地控制症状；（C）心血管和合并症管理，包括生活方式因素。从英国国家医疗服务体系（NHS）的角度来看，还没有对 ABC 途径实施情况进行正式的医疗保健成本分析，以优化 AF 的管理。我们的目的是估计英国每年 AF 患者的数量，直至 2040 年，以及他们的发病率和死亡率，以及相关的医疗保健费用，其次，估计实施 ABC 途径对发病率和死亡率的改善，并对成本的影响。
2020 年，预计有 1463538 名 AF 患者，每年导致 2.86 亿英镑的中风护理费用和 1.91 亿英镑的出血护理费用。到 2030 年，预计将有 2115332 名 AF 患者，导致 6.66 亿英镑的中风医疗保健费用和 4.44 亿英镑的出血相关医疗保健费用。到 2040 年，预计这一数字将上升至 2856489 名 AF 患者，当年的中风医疗保健费用为 10.96 亿英镑，出血相关医疗保健费用为 7.31 亿英镑。如果 2040 年患者采用 ABC 途径进行管理，这可能会预防 3724 至 18622 次中风和 5378 至 26890 次出血，并根据采用途径的患者比例挽救 16131 至 80653 条生命。这将相当于当年节省 1.439 亿至 7.196 亿英镑的费用。
我们估计，在未来几十年，英国 NHS 与 AF 相关的中风、出血和死亡率将带来巨大的医疗保健负担。如果患者采用基于 ABC 途径的整体或综合护理方法进行管理，这可能会预防中风和出血，从而大大降低 NHS 的医疗保健成本，并挽救生命。
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