Atrial fibrillation epidemic and hospitalizations: how to turn the rising tide?

Numerous countries worldwide are facing the major challenge of rising healthcare expenditure, a concern driven particularly by advancing medical treatments and aging population structures. In the United States over the past 50 years, increasing national healthcare expenditure has consistently outpaced growth in real gross domestic product per capita, exceeding every other country to peak at 18% of the gross domestic product in 2012.1 Given that hospitals are the largest contributor to each dollar spent on health care, the characterization of hospitalization trends is a logical first step in identifying possible opportunities to intervene and slow the rising demands on healthcare systems. Article see p 2371 It is in this context that Patel and colleagues describe contemporary trends of hospitalizations for atrial fibrillation (AF) in the current issue of Circulation .2 An increasing number of recent studies have highlighted the emergence of AF as a growing epidemic.3,4 Although the morbidity and mortality associated with this most common arrhythmia has been increasingly well characterized, few studies have comprehensively described the effect of rising AF rates on hospital use on a national scale. Using data from the Nationwide Inpatient Sample, Patel and colleagues therefore characterized the trend of hospitalization rates for AF in the United States from 2000 to 2010. They found an overall 23% growth in AF hospitalizations, importantly noting that the increase was particularly prominent in elderly patients. More than two-thirds of the patients were >65 years of age, and those >80 years of age had an exponential increase in hospitalization rates (9361 per million in 2001 to 11 045 per million in 2010). Furthermore, despite a static mean length of stay and declining in-hospital mortality associated with AF hospitalizations, inflation-adjusted costs from these hospitalizations rose from $6410 in 2001 to $8439 in 2010. As a …