Emergency Department Visits for Atrial Fibrillation in the United States: Trends in Admission Rates and Economic Burden From 2007 to 2014

Abstract

Background: Atrial fibrillation (AF) is an increasingly prevalent public health problem and one of the most common causes of emergency department (ED) visits. We aimed to investigate the trends in ED visits and hospital admissions for AF.

Methods and results: This is a repeated cross-sectional analysis of ED visit-level data from the Nationwide Emergency Department Sample for 2007 to 2014. We identified adults who visited EDs in the United States, with a principal diagnosis of AF. A sample of 864 759 ED visits for AF, representing a weighted total of 3 886 520 ED visits, were analyzed. The annual ED visits for AF increased by 30.7% from 411 406 in 2007 (95% confidence interval, 389 819-432 993) to 537 801 (95% confidence interval, 506 747-568 855) in 2014. Patient demographics remained consistent, with an average age of 69 to 70 years and slight female predominance (51%-53%) throughout the study period. Hospital admission rates were stable at ≈70% between 2007 and 2010, after which they gradually declined to 62% in 2014 (P_trend=0.017). Despite the decline in hospital admission rates, AF hospitalizations increased from 288 225 in 2007 to 333 570 in 2014 because of the increase in total annual ED visits during the study. The adjusted annual charges for admitted AF patients increased by 37% from $7.39 billion in 2007 to $10.1 billion in 2014.

Conclusions: Annual ED visits and hospital admissions for AF increased significantly between 2007 and 2014, despite a reduction in admission rates. These data emphasize the need for widespread implementation of effective strategies aimed at improving the management of patients with AF to reduce hospital admissions and the economic burden of AF.

Keywords: atrial fibrillation; economic burden; emergency department visits; hospitalization.

Figure 1

Changes in emergency department (ED) visits for atrial fibrillation (AF), admission rates, baseline patient characteristics, and comorbidities between 2007 and 2014. The percentage change in ED visits and hospital admissions as well as patient characteristics and major comorbidities are shown. Over the study period, there was a significant trend toward sicker patients presenting to the ED with AF, with an increasing prevalence of hypertension (HTN), diabetes mellitus (DM), congestive heart failure (CHF), chronic kidney disease (CKD), and chronic obstructive pulmonary disease (COPD).

Figure 2

Trends in adult emergency department (ED) visits and atrial fibrillation (AF) ED visits in the United States (2007–2014). The annual volume of ED visits for AF increased significantly from 2007 to 2014, whereas the admission rates gradually declined during the same period. For comparison, all ED visits and admission trends are displayed.

Figure 3

Total annual charges for atrial fibrillation (AF)–related emergency department (ED) visits, resulting in discharge or hospital admissions in the United States (2007–2014). The total annual charges for AF ED visits resulting in discharge and admissions increased significantly from 2007 to 2014. The significant increase in the economic burden of hospital admissions for AF is driven by a combination of the increasing total number of ED visits and hospital admissions and a 37% increase in the median per‐patient hospitalization charge over the study period.

Figure 4

Median hospital charges (adjusted for inflation) per patient: atrial fibrillation (AF) emergency department visits resulting in discharge or hospital admission. The adjusted median per‐patient hospital charges for admitted patients with AF increased significantly in the United States from 2007 to 2014. This was one of the major contributors to the significant increase in the total AF hospitalization economic burden during the study period.