Becker's Hospital Review

18 Executive Briefing Sponsored by: Cryoballoon Technology: Reducing Atrial Fibrillation's $26B Cost to the US Health System, One Hospital at a Time A trial fibrillation, a rapid and irregular heartbeat, is putting a growing number of Americans at risk of heart failure and stroke, and in turn dramatically increasing the clini- cal and financial burden on U.S. hospitals. The condition affects more than 3.5 million Americans, but the likelihood of developing AF increases with age, so it dispro- portionately affects seniors. Roughly one in 25 U.S. adults over age 60 has AF, with the rate increasing to one in 10 Americans over age 80. As the population ages and other risk factors such as obesity, hypertension, diabetes and cardiovascular disease continue to grow, the prevalence of AF is expected to double by 2035. While the condition itself is not life threatening, AF seriously impacts one's health by increasing the likelihood of stroke five times and increasing the risk of heart failure three times. In fact, 17 percent of all patients admitted to hospitals in the U.S. have some type of arrhythmia, or irregular heart rhythm. And once admitted for a stroke or heart failure, patients with AF don't fare as well as non-AF patients. The condition doubles the rate of death from stroke, and increases the risk of morbidity and mor- tality from heart failure. Treating patients with AF proves complex and costly for hospi- tals. Fortunately, hospitals have several opportunities to reduce costs and improve outcomes for patients with arrhythmia. During a webinar hosted by Becker's Hospital Review, Hae Lim, PhD, senior principal scientist, and Mark Burton, director of market access at Medtronic, reviewed the clinical and econom- ic burden of AF, outlined potential opportunities to improve care and compared the economic impact of various treatments. Samir Mody, vice president for Healthcare Economics and Re- imbursement at Medtronic, expanded on those sentiments. AF's burden on hospitals and the U.S. healthcare system AF patients put greater financial pressure on hospitals than non-AF patients. AF patients are twice as likely as non-AF pa- tients to be hospitalized for any reason, four times as likely to be hospitalized for cardiac events and eight times as likely to have multiple cardiovascular hospitalizations. Medtronic estimates the average hospital has anywhere from 100 to 200 admissions with a primary diagnosis of AF during a single year. Because of the risks associated with treating AF and the prevalence of the condition, this takes a financial toll on the U.S. healthcare system, costing roughly $26 billion per year. On a per-patient level, the average patient with AF incurs a net annual incremental cost of about $8,700, which is 73 percent more than the healthy population, according to Mr. Mody. For AF patients with a history of heart failure, those costs can grow upwards of $33,000. Mr. Mody relayed the burden of AF hospitalizations on hospi- tal and payer finances and said Medtronic is focusing on this patient population and investing in technology to stem the tide of this condition. Opportunities to improve clinical care and outcomes "Patients with AF have a significantly lower quality of life," Mr. Mody said. "It cuts across all dimensions of health and physical wellbeing." Two main treatment pathways exist for AF patients: reduce the risk of stroke and/or manage symptoms. For stroke pre- vention, drug-based therapy, such as warfarin and novel oral anticoagulants, can prevent the formation of additional blood clots. Patients who cannot manage stroke risk with drugs may choose to undergo an invasive surgical procedure that clos- es off the left atrial appendage, where blood clots often form during irregular heartbeats. As for managing AF symptoms, patients usually start with drug therapy and are ramped up as necessary. Following drug ther- apy, other options for some types of AF include catheter and surgical ablation, both of which destroy heart tissue and the as- sociated electrical activity causing arrhythmias. AF is complex, but hospitals and clinicians have three main opportunities to improve clinical AF care. The first is an ex- pedient, accurate diagnosis. Patients may spend considerable "Patients with AF have a significantly lower quality of life. ... It cuts across all dimensions of health and physical wellbeing." — Samir Mody, Vice President for Healthcare Economics and Reimbursement, Medtronic

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