Prescription Medication Use and Expenditure of Atrial Fibrillation in the United States.

Abstract

Objectives: To study the national trends of anticoagulants, antiarrhythmic drugs (AAD), and expenditures in civilian non-institutionalized AF population.

Methods: The Medical Expenditure Panel Survey (MEPS) was queried from January 2016 to December 2021 to identify adults (age ≥ 18 years) with a diagnosis of AF utilizing ICD-10-CM code "I48". Prevalence of anticoagulants, AAD, and its expenditure and AF expenditure across clinical settings in the United States were estimated. The predictors of anticoagulant use were identified utilizing multivariate logistic regression analysis.

Results: A total of 17.3 million AF adults were identified, of which 46.5% were female, 89.6% were White, and ∼70% were middle/high-income with prevalent comorbidities of hypertension (75.3%) and coronary heart disease (30%). The mean CHA₂DS₂ VASc score was 3.2, and 40% had a score of ≥4. In the US, an average of $26,103 (2021 inflation-adjusted) was spent per year per adult with AF for health-related expenditures. The prevalence of direct oral anticoagulants (DOAC) and Class I AAD use has increased; in contrast, vitamin K antagonists (VKA) use has declined. DOAC-related per-person annual expenses increased from $849 in 2016 to $1,929 in 2021. In those with a CHA₂DS₂ VASc score of ≥2, female sex and the presence of coronary heart disease were associated with a lower likelihood of anticoagulant use.

Conclusions: AF is a costly condition in which prescription medication use, like DOACs and class III AADs, are significant contributors.