Article Text

Original research article
Increasing trends in hospital care burden of atrial fibrillation in Korea, 2006 through 2015
  1. Daehoon Kim1,
  2. Pil-Sung Yang1,2,
  3. Eunsun Jang1,
  4. Hee Tae Yu1,
  5. Tae-Hoon Kim1,
  6. Jae-Sun Uhm1,
  7. Jong Youn Kim1,
  8. Hui-Nam Pak1,
  9. Moon-Hyoung Lee1,
  10. Boyoung Joung1,
  11. Gregory Y H Lip3,4
  1. 1Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Republic of Korea
  2. 2Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
  3. 3Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
  4. 4Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
  1. Correspondence to Proffessor Boyoung Joung, Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul 03722, Republic of Korea; cby6908{at} and Proffessor Gregory Y H Lip, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, Englandv B15 2TT, UK; g.y.h.lip{at}


Objective Temporal changes in the healthcare burden of atrial fibrillation (AF) are less well known in rapidly ageing Asian countries. We examined trends in hospitalisations, costs, treatment patterns and outcomes related to AF in Korea.

Methods Using the National Health Insurance Service (NHIS) database involving the entire adult Korean population (n=41 701 269 in 2015), we analysed a nationwide AF cohort representing 931 138 patients with AF. We studied all hospitalisations due to AF from 2006 to 2015.

Results Overall, hospitalisations for AF increased by 420% from 767 to 3986 per 1 million Korean population from 2006 to 2015. Most admissions occurred in patients aged ≥70 years, and the most frequent coexisting conditions were hypertension, heart failure and chronic obstructive pulmonary disease. Hospitalisations mainly due to major bleeding and AF control increased, whereas hospitalisations mainly due to ischaemic stroke and myocardial infarction decreased. The total cost of care increased even after adjustment for inflation from €68.4 million in 2006 to €388.4 million in 2015, equivalent to 0.78% of the Korean NHIS total expenditure. Overall in-hospital mortality decreased from 7.5% in 2006 to 4.3% in 2015. The in-hospital mortality was highest in patients ≥80 years of age (7.7%) and in patients with chronic kidney disease (7.4%).

Conclusions AF hospitalisations have increased exponentially over the past 10 years in Korea, in association with an increase in comorbid chronic diseases. Mortality associated with AF hospitalisations decreased during the last decade, but hospitalisation costs have markedly increased.

  • atrial fibrillation
  • health care economics
  • quality and outcomes of care

Statistics from


  • BJ and GYHL are joint senior authors.

  • DK and P-SY contributed equally.

  • Contributors BJ and GYHL contributed to the conception and design of the work and critical revision of the manuscript. DK contributed to the conception and design of the work, interpretation of data for the work and drafting of the manuscript. P-SY and EJ contributed to the acquisition and analysis of data for the work. HTY, T-HK, J-SU, JYK, H-NP and M-HL contributed to the conception and design of the work and revising the manuscript. All authors approved the final version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This study was supported by a research grant from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (NRF-2017R1A2B3003303), and grants from the Korean Healthcare Technology R&D project funded by the Ministry of Health & Welfare (HI16C0058, HI15C1200).

  • Competing interests GYHL: consultant for Bayer/Janssen, BMS/Pfizer, Biotronik, Medtronic, Boehringer Ingelheim, Novartis, Verseon and Daiichi-Sankyo. Speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim and Daiichi-Sankyo. No fees are directly received personally.

  • Patient consent Not required.

  • Ethics approval This study was approved by the Institutional Review Board of Yonsei University Health System (4-2016-0179).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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