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Cost of Atrial Fibrillation by State
New Analysis Illustrates the Hidden Burden of Atrial Fibrillation on Healthcare Spending and Resources in Each State
"AFib in America: State Impact Reports" Illustrate the Disconnect Between AFib's Impact and the Public Health Resources Available
WASHINGTON, March 22, 2011 /PRNewswire/ -- Despite the high costs and heavy demand for health services associated with atrial fibrillation (or AFib), a report released today suggests that states may not be providing residents with the necessary resources to address and manage this common chronic disease.
AFib in America: State Impact Reports identify key state-by-state statistics, resources and state health department programs related to the burden of AFib. It was written by The George Washington University School of Public Health and Health Services (GWU) and funded by sanofi-aventis U.S. LLC, the sponsor of AF Stat™: A Call to Action for Atrial Fibrillation. The full interactive reports are available at www.AFStat.com.
Characterized by a rapid and irregular heartbeat, AFib is the most common form of heart arrhythmia. It affects approximately 2.5 million Americans, and its prevalence is expected to increase as the U.S. population ages.(1) It increases risk for stroke by five times,(2) worsens other heart diseases(3) and doubles the risk of death.(4) Patients with AFib tend to use more healthcare services than patients without AFib, including time in the hospital.(5)
"Atrial fibrillation is costly and can become debilitating as it worsens, yet it does not share the same priority on the public health agenda that other chronic diseases have," said Christy Ferguson, Professor, Department of Health Policy, School of Public Health and Health Services, GWU. "This report calls attention to the lack of resources about AFib, alerting policymakers, state health officials, and other health leaders to better educate residents about this common but misunderstood disease."
Among the key findings, the reports show that AFib has an immense, but unrecognized, burden. In fact, Medicare payments where AFib was the primary diagnosis totaled almost $2.3 billion in 2007. Nearly half of these costs were related to hospital inpatient stays – a burden specifically felt by local healthcare providers.
However, despite the significant health and economic burden of AFib, not a single state has a public health program specifically dedicated to educating or supporting patients with AFib. State-level public health programs that do address AFib tend to only include the disease as a part of stroke and heart disease prevention efforts, rather than focusing on the specific risks and consequences of AFib.
"Just as patients need to comprehensively manage their AFib, health leaders need to develop and implement comprehensive programs that address the impact of AFib in their home states," said Senator Bill Frist, M.D., former Senate Majority Leader and policy advisor for AF Stat. "The AFib in America: State Impact Reports are an important first step to helping them recognize that need and put an AFib action plan in place."
Also released today by AF Stat, the AFib Evaluator is an online self-assessment tool designed to provide insight into a user's risk for developing AFib, or a diagnosed patient's baseline knowledge of AFib. The AFib Evaluator serves as an example of the type of patient education tools that AFib patients need, but currently lack
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According to Senator Frist, these two new resources take on particular significance as federal and state policymakers join private payers to reduce the cost of healthcare.
"It may appear that many of AFib's costs are assumed by the federal government through Medicare, but the disease also inflicts a significant burden at the state level," he said. "Individual states feel AFib's impact on their residents' health, productivity, and quality of life. Local hospitals and providers often assume the burden of repeated hospitalizations and care for AFib patients. As health leaders work to lower the costs of expensive chronic diseases, AFib must be a part of the discussion."
Methodology
To illustrate the role of AFib with regard to healthcare service utilization and costs in each state, GWU conducted a descriptive analysis of AFib patients using Medicare Standard Analytic Files for 2007, including five percent sample and 100 percent files. To assess use and costs for AFib patients insured by other payer types GWU supplemented the analysis with data on hospital inpatient stays using 2007 discharge data for all payers from State Inpatient Databases compiled by the Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality.(6) GWU conducted this analysis for 25 states for which these data were available for public use.(7)
To determine what state AFib-related programs were available at the state level, GWU:
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Reviewed the literature published between 2000 and 2010 concerning state efforts related to public awareness of AFib and whether there are best practices for public health programs for AFib.
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Reviewed materials from Medicare, federal initiatives (CDC, NIH), and state health departments in all 50 states and the District of Columbia.
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Evaluated data sources including standard legal databases, CDC and NIH programs, and publicly available state program resources.
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Examined all 50 state websites.
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Contacted state health officials to confirm website findings and request any additional written information.
About the AF Stat Report Series
The AF Stat Report Series is designed to better illustrate the burden of atrial fibrillation, and to address the four priority areas recommended by the AF Stat Call to Actiondocument: policy and advocacy, management, education and quality. The fourth report in this series, AFib in America: State Impact Reports, was written by GWU and funded by sanofi-aventis U.S. LLC, which is the sponsor for AF Stat: A Call to Action for Atrial Fibrillation. It is designed to help health leaders measure the prevelance and impact of AFib on Medicare spending and state health resources; define health service utilization patterns surrounding AFib; and identify state-based programs to manage the disease. GWU maintained editorial control and the conclusions expressed in the report are those of the author.
(1) Go AS. "Prevelance of Atrial Fibrillation in Adults: National Implications for Rhythm Management and Stroke Prevention: The Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study." Journal of American Medical Association. May 9, 2001-Vol 285, No. 18. |
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(2) Wolf PA, Abbott RD, Kannel, WB. Atrial fibrillation as an independent risk factor for stroke: The Framingham Study. Stroke. 1991;22;983-988. |
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(3) Fuster V, Ryden LE, Cannom DS, et al.ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006;114:e257-e354. |
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(4) Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: The Framingham Heart Study. Circulation. 1998;98:946-952. |
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Organizations." Adv Ther. (2009) 26(9):847-857. |
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(5) Lee W. Lamas G. Balu S., et al. "Direct treatment cost of atrial fibrillation in the elderly American population: a Medicare perspective." Journal of Medical Economics. 2008. 11. P.281-298. |
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(6) HCUP State Inpatient Databases (SID). Healthcare Cost and Utilization Project (HCUP). 2007. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/sidoverview.jsp Last accessed Feb. 8, 2011 |
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(7) The states included in our HCUP SID analysis are: Arizona, Arkansas, California, Colorado, Florida, Hawaii, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Nebraska, Nevada, New Jersey, New York, North Carolina, Rhode Island, South Carolina, South Dakota, Utah, Vermont, Washington, West Virginia and Wisconsin. |
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Featured Angina| Acute Coronary Syndrome and Heart Disease Interviews
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Highlights of Article by Dr. Erik Hess et of Mayo Clinic ;CIRCOUTCOMES 2012
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Chest pain is the 2nd most common reason patients come to EDs across the United States
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Initial testing – including information obtained from the history, physical exam, electrocardiogram, and cardiac troponin – identifies > 98% of heart attacks
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To avoid missing a diagnosis of heart attack or pre-heart attack symptoms, emergency physicians often admit patients to observation units or to the hospital for extensive diagnostic testing, including stress testing
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This results in false positive test results, unnecessary exposure to radiation, and unnecessary downstream procedures such as stent placement in arteries of the heart
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Decision aids are evidence-based tools designed to educate and engage patients in decisions regarding their care
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We hypothesized that patients who were educated regarding their future risk for a heart attack and engaged in the decision of whether to be admitted to the observation unit for stress testing or to follow-up with a Mayo Clinic heart doctor in the next 72 hours would have greater knowledge about their short-term risk for heart attack, be more aware of the management options, and choose less intensive approaches to evaluation
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We randomly assigned 204 patients who came to the ED with chest pain and were being considered for observation unit admission to the decision aid or to usual care
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Decision aid patients:
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Had greater knowledge regarding their short-term risk for a heart attack
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Less frequently decided to be admitted to the observation unit for stress testing
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Had 4 times greater engagement in the decision making process
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Had no adverse events within 30 days of the ED visit
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Take home points
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Patients want to be educated and engaged in decisions regarding their care
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Once properly informed and engaged in treatment decisions, patients often choose less intensive treatment options
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Integrated health systems like the Mayo Clinic in which physicians collaboratively work together to provide ER patients ready access to outpatient follow-up have potential to improve the value of Emergency care
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Glucose, Insulin and Potassium (“GIK”) TO MINIMIZE IMPACT OF HEART ATTACKS BEFORE PATIENTS GET TO THE HOSPITAL
Study puts life-saving drugs in the hands of paramedics, decreasing rate of cardiac arrest and death from heart attacks
CHICAGO (March 27, 2012) — Paramedics can potentially reduce someone’s chances of having a cardiac arrest or dying by 50 percent by immediately administering a mixture of glucose, insulin and potassium (“GIK”) to people having a heart attack, according to research presented today at the American College of Cardiology’s 61st Annual Scientific Session. The Scientific Session, the premier cardiovascular medical meeting, brings cardiovascular professionals together to further advances in the field.
The study showed that patients who received GIK immediately after being diagnosed with acute coronary syndrome — which indicates a possible heart attack is either in progress or on the way — were 50 percent less likely to have cardiac arrest (a condition in which the heart suddenly stops beating) or die than those who received a placebo, although the treatment did not prevent the heart attack from occurring. The reduction in in-hospital cardiac arrest or death was a “secondary endpoint”, so statistically was not definitive, but was consistent with how GIK seems to work in experimental models of heart attack.
The effect was also present for patients with ST-elevation heart attacks, which require immediate treatment. For those patients, immediate GIK was associated with a 60 percent reduction in in-hospital cardiac arrest or death.
“When started immediately in the home or on the way to the hospital — even before the diagnosis is completely established — GIK appears not completely prevent any heart attack from occurring, but appeared in this trial to reduce the size of heart attacks and to reduce by half the risk of having a cardiac arrest or dying,” said Harry P. Selker, MD, MSPH, executive director of the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, who led the study with Joni Beshansky, RN, MPH, co-principal investigator and project director. “Acute coronary syndromes represent the largest cause of death in this country. GIK is a very inexpensive treatment that appears to have promise in reducing those deaths and morbidity.”
The cost of the treatment is about $50.
“Because the trial is the first to show GIK could be effective when used by paramedics in real-world community settings, it could have important implications for the treatment of heart attacks,” Dr. Selker said. Previous clinical trials have shown no consistent effect, likely because the GIK was given too late to help. This study, the “IMMEDIATE Trial,” was the first to test the effectiveness of administering GIK at the very first signs of a threatening heart attack, in the community, rather than waiting hours until the diagnosis was well-established at a hospital, as done in previous clinical trials.
“We wanted to do something that is effective and can be used anywhere,” said Dr. Selker. “We’ve done a lot of studies of acute cardiac care in emergency departments and hospitals, but more people die of heart attacks outside the hospital than inside the hospital. Hundreds of thousands of people per year are dying out in the community; we wanted to direct our attention to those patients.”
The researchers trained paramedics in 36 Emergency Medical Services systems in 13 cities across the country to administer GIK after determining that a patient was likely having a threatened or already established heart attack using electrocardiograph-based ACI-TIPI (acute cardiac ischemia time-insensitive predictive instrument) and thrombolytic predictive instrument decision support that prints patient-specific predictions on the top of an electrocardiogram. The paramedics used these predictions to decide if a patient would likely benefit from treatment. There were 911 patients randomized to receive either the GIK treatment or a placebo.
Administering GIK immediately also reduced the severity of the damage to the heart tissue from the heart attack. On average, 2 percent of the heart tissue was destroyed by the heart attack in people receiving GIK, compared with 10 percent in those who received the placebo. Although a significant proportion of suspected heart attacks are later determined to be false alarms (23 percent in this study), administering GIK does not appear to cause any harmful effects in such patients.
The research team will follow up with study participants at six and 12 months to evaluate the longer-term benefit of the GIK treatment.
This study was funded by the NIH’s National Heart, Lung and Blood Institute.
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Amazon.com 's Editorial Reviews
Angina: New Ways to Treat
Chronic Chest Pain
Part of the award winning public television series Healthy head
/Healthy Mind. It's one of the scariest medical symptoms for people who are generally healthy: a tightening, painful feeling in the chest known as Angina. In some cases this chest pain can be a serious warning that requires immediate treatment. But for the millions of people with chronic, stable angina the discomfort is something that can be readily managed with a variety of treatments. In this program we take a look at what generally causes angina, what can be done to prevent it and how it can be effectively treated with lifestyle changes, innovative drug therapies and medical procedures.
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Amazon.com Editorial Review:
Philips HeartStart Home Defibrillator (AED)
Be prepared for the unexpected.
When sudden cardiac arrest (SCA) strikes, the electrical system of the heart short circuits, causing the heart to quiver rather than pump in a normal rhythm. It typically results in the abnormal heart rhythm know as ventricular fibrillation (VF). It usually happens without warning and the majority of people have no previously recognized symptoms of heart disease. And it most often happens at home. For the best chance of survival from SCA caused by VF, a defibrillator should be used within 5 minutes. Yet, less than 1 in 20 people survive largely because a defibrillator does not arrive in time.
Just as seat belts or airbags do not save every life in a traffic accident, a defibrillator will not save every person who suffers a sudden cardiac arrest. Yet many lives could be saved if more people could be reached more quickly.
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