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In-hospital management of atrial fibrillation: the CHADS2 score predicts increased cost.

https://arctichealth.org/en/permalink/ahliterature134740
Source
Can J Cardiol. 2011 Jul-Aug;27(4):506-13
Publication Type
Article
Author
Mark A Kotowycz
Kristian B Filion
Jacqueline Joza
Doris Dube
Matthew R Reynolds
Louise Pilote
Mark J Eisenberg
Vidal Essebag
Author Affiliation
Division of Cardiology, McGill University Health Centre, Montreal, Québec, Canada.
Source
Can J Cardiol. 2011 Jul-Aug;27(4):506-13
Language
English
French
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Atrial Fibrillation - diagnosis - economics - epidemiology - therapy
Atrial Flutter - diagnosis - economics - therapy
Bayes Theorem
Comorbidity
Female
Health Status Indicators
Hospitalization - economics
Hospitals, Teaching
Humans
Male
Middle Aged
Quebec
Abstract
Hospitalizations for atrial fibrillation (AF) impose a substantial burden on our health care system, and AF management strategies are increasingly focused on hospitalization reduction. The objectives of this study were to determine the cost of hospitalization for AF and to identify the main determinants of this cost in a Canadian setting.
Our study population consisted of patients hospitalized for AF and/or atrial flutter at a tertiary care hospital in Canada between April 1, 2001, and March 31, 2007. Patient-level demographics and data on clinical resource use and cost of treatment were collected from a computerized resource use and cost accounting system. The main determinants of in-hospital costs were identified through Bayesian model averaging.
Data were collected on 325 consecutive hospitalizations for AF. The median length of stay was 5 days (interquartile range [IQR], 3-9). The mean cost of an AF admission was CAD$4740 (SD = CAD$4457), and the median was CAD$3532 (IQR, CAD$2013-CAD$5944). Multivariate analysis identified 2 independent predictors of increased cost: CHADS2 score (relative increase in cost: 1.24; 95% CI, 1.16-1.33) and warfarin use (relative increase in cost: 1.41; 95% CI, 1.20-1.67). These 2 variables were also independent predictors of increased length of stay.
The main clinical determinants of increased cost and increased length of stay were CHADS2 score and warfarin use. Strategies for reducing AF-related costs should focus on preventing hospitalization or decreasing its length in patients with high CHADS2 scores and on finding alternatives to the use of warfarin or using outpatient bridging anticoagulation to facilitate earlier hospital discharge.
Notes
Comment In: Can J Cardiol. 2011 Jul-Aug;27(4):401-321696915
PubMed ID
21546210 View in PubMed
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