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Arrhythmias and sudden death
Original research article
Increasing trends in hospitalisations due to atrial fibrillation in Australia from 1993 to 2013
  1. Celine Gallagher1,
  2. Jeroen ML Hendriks1,
  3. Lynne Giles2,
  4. Jonathan Karnon2,
  5. Clarabelle Pham2,
  6. Adrian D Elliott1,
  7. Melissa E Middeldorp1,
  8. Rajiv Mahajan1,
  9. Dennis H Lau1,
  10. Prashanthan Sanders1,
  11. Christopher X Wong1
  1. 1 Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
  2. 2 School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
  1. Correspondence to Dr Christopher X Wong, Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide SA 5000, Australia; c.wong{at}adelaide.edu.au

Abstract

Objective The aim of this study is to characterise hospitalisations due to atrial fibrillation (AF) compared with two other common cardiovascular conditions, myocardial infarction (MI) and heart failure (HF), in addition to the associated economic burden of these hospitalisations and contribution of AF-related procedures.

Methods The primary outcome measure was the rate of increase of AF, MI and HF hospitalisations from 1993 to 2013. The rate of increase of AF-related procedures including cardioversion and ablation were also collected, in addition to direct costs associated with hospitalisations for each of these three conditions.

Results AF hospitalisations increased 295% over the 21-year period to a total of 61 424 in 2013. In comparison, MI and HF hospitalisations increased by only 73% and 39%, respectively, over the same period. Considering population changes, there was an annual increase in AF hospitalisations of 5.2% (incidence rate ratio [IRR] 1.052; 95% CI 1.046 to 1.059; p<0.001). In contrast, there was a 2.2% increase per annum for MI (IRR 1.022; 95% CI 1.017 to 1.027; p<0.001) and negligible annual change for HF hospitalisations (IRR 1.000; 95% CI 0.997 to 1.002; p=0.78). Cardioversion and AF ablation increased by 10% and 26% annually, respectively. AF hospitalisation costs rose by 479% over the 21-year period, an increase that was more than double that of MI and HF.

Conclusions The burden of AF hospitalisations continues to rise unabated. AF has now surpassed both MI and HF hospitalisations and represents a growing cost burden. New models of healthcare delivery are required to stem this growing healthcare burden.

  • atrial fibrillation
  • hospitalisations
  • healthcare burden
  • ablation
  • cardioversion

https://doi.org/10.1136/heartjnl-2018-314471

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    Footnotes

    • Contributors CG, LG, PS and CXW: had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. CG, PS and CXW: study concept and design; drafting of the manuscript. CG, JMLH, LG, JK, CP, ADE, MEM, RM, DHL, PS and CXW: critical revision of the manuscript for important intellectual content.

    • Funding CG is supported by a Leo J Mahar scholarship from the University of Adelaide. JMLH and ADE are supported by an Early Career Fellowships from the National Heart Foundation of Australia. JMLH is supported by the Derek Frewin Lectureship from the University of Adelaide. MEM is supported by a Postgraduate Scholarship from the National Health and Medical Research Council of Australia. RM is supported by an Early Career Fellowship from the National Health and Medical Research Council of Australia and by the Leo J Mahar Lectureship from the University of Adelaide. DHL is supported by the Robert J Craig Lectureship from the University of Adelaide. PS is supported by Practitioner Fellowships from the National Health and Medical Research Council of Australia and the National Heart Foundation of Australia. CXW is supported by an Early Career Fellowship from the National Health and Medical Research Council of Australia. Conflict of Interest Disclosures: PS reports having served on the advisory board of Biosense-Webster, Medtronic, St Jude Medical, Boston Scientific and CathRx. PS reports that the University of Adelaide has received on his behalf lecture and/or consulting fees from Biosense-Webster, Medtronic, St Jude Medical, and Boston Scientific. PS reports that the University of Adelaide has received on his behalf research funding from Medtronic, St Jude Medical, Boston Scientific, Biotronik and LivaNova. CXW reports that the University of Adelaide has received on his behalf lecture, travel and/or research funding from Novartis, Servier, Boehringer-Ingelheim and Medtronic. All other authors have no conflicts.

    • Competing interests PS reports having served on the advisory board of Biosense-Webster, Medtronic, St Jude Medical, Boston Scientific and CathRx. PS reports that the University of Adelaide has received on his behalf lecture and/or consulting fees from Biosense-Webster, Medtronic, St Jude Medical and Boston Scientific. PS reports that the University of Adelaide has received on his behalf research funding from Medtronic, St Jude Medical, Boston Scientific, Biotronik and LivaNova. CXW reports that the University of Adelaide has received on his behalf lecture, travel and/or research funding from Novartis, Servier, Boehringer-Ingelheim and Medtronic.

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

    • Data sharing statement All data used in this study are available from the Australian Institute of Health and Welfare.