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ambulatory care, atrial fibrillation, cost analysis, nurse specialists



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


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.