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Keywords

ambulatory care, atrial fibrillation, cost analysis, nurse specialists

 

Authors

  1. Thrysoee, Lars PhD, MLP, RN
  2. Kidholm, Kristian PhD
  3. Rasmussen, Maja Kjaer MSc
  4. Brandes, Axel PhD

Abstract

Aims: The aim of this study was to assess healthcare utilization costs of a dedicated outpatient clinic for patients with atrial fibrillation (AF).

 

Methods: 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.

 

Results: A total of 1552 patients were included, hereof 850 in the intervention group. Total AF-related costs were [Euro sign]2746 for the control group and [Euro sign]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 ([Euro sign]522 vs [Euro sign]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.

 

Conclusion: 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.