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. 2017 Jan;47(1):56-64.
doi: 10.4070/kcj.2016.0045. Epub 2016 Dec 26.

The Trends of Atrial Fibrillation-Related Hospital Visit and Cost, Treatment Pattern and Mortality in Korea: 10-Year Nationwide Sample Cohort Data

Hancheol Lee  1 , Tae-Hoon Kim  2 , Yong-Soo Baek  2 , Jae-Sun Uhm  2 , Hui-Nam Pak  2 , Moon-Hyoung Lee  2 , Boyoung Joung  2
Affiliations

The Trends of Atrial Fibrillation-Related Hospital Visit and Cost, Treatment Pattern and Mortality in Korea: 10-Year Nationwide Sample Cohort Data

Hancheol Lee et al. Korean Circ J. 2017 Jan.

Abstract

Background and objectives: The change of in-hospital and out-hospital treatments, and hospital costs for atrial fibrillation (AF) were not well known in rapidly aging Asian countries. This study is to examine the trends of AF management and outcomes in Korea.

Subjects and methods: In the sample cohort from Korean National Health Insurance Data Sample Cohort (K-NHID-Sample Cohort) from 2004 through 2013, we identified patients with AF and hospital visit records using Korean Classification of Diseases, 6th Revision (KCD-6). Hospital cost, prescribed medications, radiofrequency catheter ablation (RFCA), morbidity and mortality were identified.

Results: AF-related hospitalization and outpatient clinic visits increased by 2.19 and 3.06-fold, respectively. While the total cost increased from 3.6 to 11.3 billion won (p<0.001), the mean cost per patient increased from 0.68 to 0.83 million won (p<0.001). Although the mean CHA2DS2-VASc score increased from 3.5 to 4.4 in the total AF population, the proportion of patients who receive anticoagulation therapy with warfarin showed no significant change for the decade. The proportion of hospitalization for RFCA was increased (0.4% to 1.1%, p<0.001). All-cause mortality (6.7% to 5.0%), cardiovascular mortality (1.4% to 1.1%) and stroke-related death (1.3% to 0.8%) showed a modest decrease from 2004 to 2013.

Conclusion: During the last decade, AF-related hospitalization and outpatient clinic visits have increased with the increase of many other comorbidities, whereas the rate of anticoagulation did not improved. Although mortality in patients with AF showed a modest decrease from 2004 to 2013, proper anticoagulation therapy is warranted for the improvement of public health.

Keywords: Atrial fibrillation; Hospital costs; National health programs.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Fig. 1
Fig. 1. According to the progressive increase in the prevalence of AF, the number of hospitalizations and the number of outpatient clinic visits had the progressive increase from 2004 to 2013. (A) Trends of the number of AF population, (B) hospital visit, and (C) mean number of hospital visit per patient/year. AF: afrial fibrillation.
Fig. 2
Fig. 2. Mean medical cost per patient/year significantly increased with exponential increase of the hospitalization cost. (A) Trends of total medical cost and (B) mean medical cost.*p<0.001 for trends.
Fig. 3
Fig. 3. Patients' distribution according to CHA2DS2-VASc score.
Fig. 4
Fig. 4. The proportion of patients with anticoagulation (warfarin), and those who taking aspirin showed no significant change from 2004 to 2013. (A) Trends of the use of medication for stroke prevention in total population and (B) in patients with CHA2DS2-VASc score ≥2.
See this image and copyright information in PMC

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