Economic Impact of Atrial Fibrillation after CABG Underestimated in US

The costs associated with caring for patients who develop atrial fibrillation (AF) after undergoing coronary artery bypass graft (CABG) surgery are significantly higher compared with patients who do not develop AF after CABG, researchers report.

In a retrospective review, Dr. Marilyn Hravnak from the School of Nursing, University of Pittsburgh, and colleagues studied the use of hospital resources over 25 months, by 720 patients who underwent CABG.

Among these patients, 33.1% developed new-onset AF, according to the report in the May issue of the American Journal of Critical Care.

Compared with patients, who did not develop AF, those who did had longer hospital stays (5.8 days versus 4.4 days). They also had more days on mechanical ventilation (1.7 days versus 1.4 days) and oxygen therapy (5.0 days versus 4.1 days), and higher rates of readmission to the intensive care unit (4.6% versus 0.2%), the researchers report.

Dr. Hravnak’s team notes that patients with new-onset AF received more laboratory tests. These patients also received more medication, including cardiac drugs, heparin, diuretics and electrolytes.

Postoperative charges for AF patients were significantly higher compared with patients who did not develop AF, with a mean difference in costs of $6356 (p = 0.001)

“Our findings indicate that the economic impact of the development of this complication was underestimated in the past,” Dr. Hravnak and colleagues note.

The researchers suggest that strategies aimed at reducing the length of hospital stay, the use of less expensive drugs and the elimination of some routine tests could substantially cut the costs associated with managing AF after CABG. They also say that more effective strategies to eliminate AF after CABG need to be developed.

“We can continue to await more effective prophylactic strategies, but in the meantime the costliness of this complication compels us to find more cost-effective ways to manage the problem and the associated care once AF has occurred,” Dr. Hravnak and colleagues conclude.

Am J Crit Care 2002;11:228-238.