Long-Term Healthcare Utilization and Outcomes in Patients Hospitalized for Heart Failure With and Without Atrial Fibrillation

Abstract

The long-term association between AF and clinical outcomes, healthcare resource utilization, and healthcare costs among patients with HF remains underexplored. We conducted an exploratory analysis of 5-year outcomes among patients enrolled in the patient-centered care transitions in HF (PACT-HF) stepped-wedge cluster randomized trial who were hospitalized for HF and discharged alive between February 2015 and March 2016. Patients were stratified by baseline AF status. Administrative health databases were linked to assess mortality, rehospitalizations, emergency department visits, healthcare utilization, and costs. Mortality was analyzed using Cox proportional hazards models adjusted for baseline comorbidities. Healthcare utilization and cost differences were assessed using Wilcoxon and generalized linear models. Among 4,441 patients, 2,151 patients (48.4%) had AF at baseline. Patients with AF were older and had a higher prevalence of hypertension, stroke, and vascular disease. Patients with AF had a shorter life span (mean [SD] days alive 957.9 [697.8] vs 1,119.6 [698.2], p <0.01) and a higher 5-year all-cause mortality (adjusted HR 1.09 95% CI 1.01 to 1.17; p = 0.03) relative to those without AF. Patients with AF experienced more all-cause rehospitalizations (mean [SD] 3.2 [8.3] vs 2.6 [7.9], p = 0.03) and longer hospital length of stays (mean [SD] days 29.6 [48.6] vs 24.8 [46.9], p <0.01), but no difference in HF rehospitalizations (mean [SD] 0.9 [4.5] vs 0.8 [3.6], p = 0.24) than those without AF. Annual healthcare costs were greater in the AF cohort (mean [SD] $83,748 [114,398] vs $77,792 [114,874]) CAD. In conclusion, despite only modestly increased mortality, patients with AF experienced substantially greater healthcare utilization and cost, largely unrelated to HF-specific care. These exploratory findings underscore the need for a multidisciplinary approach to reduce morbidity and optimize care delivery for patients with HF and comorbid AF.