The Incremental Burden of Atrial Fibrillation and Heart Failure: A Real-world Claims-based Analysis

Background Atrial fibrillation (AF) and heart failure (HF) are independent and growing problems in the United States, representing a significant clinical and economic burden to the healthcare system. While the strong association between AF and HF - due to common risk factors and the ability of each condition to cause the other - has been extensively characterized, the clinical and economic burden of comorbid AF and HF is not fully understood. This study characterizes the incremental health economic burden of patients with comorbid AF and HF. Methods This retrospective analysis leveraged United Healthcare's Optum claims database from January 2007 to June 2019. Patients were included if they had a minimum of 1 inpatient or 2 outpatient claims with a diagnosis of AF or 1 inpatient claim with a primary diagnosis of HF, were 18 years of age or older, and had no record of end stage renal disease, implanted cardiac device, or rheumatic heart failure. Patients were divided into three cohorts: (1) “AF,” patients with AF and no record of heart failure (N=(311,336); (2) “Comorbid,” patients with AF and a HF hospitalization (N=51,310); and (3) “HF Hosp,” patients with a heart failure hospitalization and no record of AF (N=47,469). Study outcomes included time to stroke/TIA (Kaplan Meier), average length of hospital stay, and annual rate of healthcare utilization post-index date [all-cause (AC) hospitalizations, HF hospitalizations, emergency department (ED) visits, outpatient (OP) visits, and home health visits]. Results Comorbid patients are older (77.4 years) and sicker (Elixhauser = 10.3) than AF Only and HF Hosp Only patients (AF: 68.6 years, Elixhauser= 5.1; HF Hosp: 70.3 years, Elixhauser=8.7). The comorbid cohort had a higher risk of stroke/TIA (51%) than AF Only (36%) and HF Hosp Only (43%) at 12 years (p Conclusions Comorbid AF and HF is associated with particularly poor clinical outcomes and a substantial health economic burden. Further, HF in the absence of AF also confers worse clinical outcomes and elevated healthcare use.