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Heart, Lung and Circulation

A Call to Action to Reduce Preventable Hospitalisations and Health Care Burden Due to Atrial Fibrillation

      In line with the growing burden of modifiable cardiovascular risk factors in both developed and developing countries, the prevalence of atrial fibrillation (AF) has increased exponentially, with this upward trajectory likely to continue in coming decades [
      • Wong C.X.
      • Brown A.
      • Tse H.F.
      • Albert C.M.
      • Kalman J.M.
      • Marwick T.H.
      • et al.
      Epidemiology of atrial fibrillation: the Australian and Asia-Pacific perspective.
      ]. Indeed, there is a growing body of evidence that modifiable risk factors such as obesity, hypertension, physical inactivity, obstructive sleep apnoea, diabetes mellitus and excessive alcohol consumption contribute to the development of the AF substrate, leading to AF progression and recurrence; while targeting these risk factors has been shown to improve sinus rhythm maintenance with reverse atrial remodelling [
      • Lau D.H.
      • Nattel S.
      • Kalman J.M.
      • Sanders P.
      Modifiable risk factors and atrial fibrillation.
      ,
      • Pathak R.K.
      • Middeldorp M.E.
      • Lau D.H.
      • Mehta A.B.
      • Mahajan R.
      • Twomey D.
      • et al.
      Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study.
      ,
      • Hendriks J.M.
      • Gallagher C.
      • Middeldorp M.E.
      • Lau D.H.
      • Sanders P.
      Risk factor management and atrial fibrillation.
      ]. The lifetime risk of developing AF is estimated at 37% in adults over the age of 55 years, although lower in those with a more favourable clinical risk profile, highlighting the preventable nature of AF [
      • Weng L.C.
      • Preis S.R.
      • Hulme O.L.
      • Larson M.G.
      • Choi S.H.
      • Wang B.
      • et al.
      Genetic predisposition, clinical risk factor burden, and lifetime risk of atrial fibrillation.
      ]. Notably, recent data has shown that AF is now the most common cause of cardiovascular hospitalisation in Australia, outstripping both heart failure and myocardial infarction [
      • Gallagher C.
      • Hendriks J.M.
      • Giles L.
      • Karnon J.
      • Pham C.
      • Elliott A.D.
      • et al.
      Increasing trends in hospitalisations due to atrial fibrillation in Australia from 1993 to 2013.
      ]. As such, it is timely to ascertain the true burden of AF hospitalisations and evaluate how much of this health care burden could potentially be lessened, to ameliorate the burgeoning cost of this complex arrhythmia.

      Keywords

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      References

        • Wong C.X.
        • Brown A.
        • Tse H.F.
        • Albert C.M.
        • Kalman J.M.
        • Marwick T.H.
        • et al.
        Epidemiology of atrial fibrillation: the Australian and Asia-Pacific perspective.
        Heart Lung Circ. 2017; 26: 870-879
        • Lau D.H.
        • Nattel S.
        • Kalman J.M.
        • Sanders P.
        Modifiable risk factors and atrial fibrillation.
        Circulation. 2017; 136: 583-596
        • Pathak R.K.
        • Middeldorp M.E.
        • Lau D.H.
        • Mehta A.B.
        • Mahajan R.
        • Twomey D.
        • et al.
        Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study.
        J Am Coll Cardiol. 2014; 64: 2222-2231
        • Hendriks J.M.
        • Gallagher C.
        • Middeldorp M.E.
        • Lau D.H.
        • Sanders P.
        Risk factor management and atrial fibrillation.
        Europace. 2021; 23: ii52-ii60
        • Weng L.C.
        • Preis S.R.
        • Hulme O.L.
        • Larson M.G.
        • Choi S.H.
        • Wang B.
        • et al.
        Genetic predisposition, clinical risk factor burden, and lifetime risk of atrial fibrillation.
        Circulation. 2018; 137: 1027-1038
        • Gallagher C.
        • Hendriks J.M.
        • Giles L.
        • Karnon J.
        • Pham C.
        • Elliott A.D.
        • et al.
        Increasing trends in hospitalisations due to atrial fibrillation in Australia from 1993 to 2013.
        Heart. 2019; 105: 1358-1363
        • Woods T.J.
        • Ngo L.
        • Speck P.
        • Kaambwa B.
        • Ranasinghe I.
        Thirty-Day unplanned readmissions following hospitalisation for atrial fibrillation in Australia and New Zealand.
        Heart Lung Circ. 2022; 31: 944-953
        • Amin A.N.
        • Jhaveri M.
        • Lin J.
        Temporal pattern and costs of rehospitalization in atrial fibrillation/atrial flutter patients with one or more additional risk factors.
        J Med Econ. 2012; 15: 548-555
        • Johnson B.H.
        • Smoyer-Tomic K.E.
        • Siu K.
        • Walker D.R.
        • Sander S.
        • Huse D.
        • et al.
        Readmission among hospitalized patients with nonvalvular atrial fibrillation.
        Am J Health Syst Pharm. 2013; 70: 414-422
        • Naderi S.
        • Wang Y.
        • Miller A.L.
        • Rodriguez F.
        • Chung M.K.
        • Radford M.J.
        • et al.
        The impact of age on the epidemiology of atrial fibrillation hospitalizations.
        Am J Med. 2014; 127 (158.e1-7)
        • Gehi A.K.
        • Deyo Z.
        • Mendys P.
        • Hatfield L.
        • Laux J.
        • Walker T.J.
        • et al.
        Novel care pathway for patients presenting to the emergency department with atrial fibrillation.
        Circ Cardiovasc Qual Outcomes. 2018; 11e004129
        • Ptaszek L.M.
        • White B.
        • Lubitz S.A.
        • Carnicelli A.P.
        • Heist E.K.
        • Ellinor P.T.
        • et al.
        Effect of a multidisciplinary approach for the management of patients with atrial fibrillation in the emergency department on hospital admission rate and length of stay.
        Am J Cardiol. 2016; 118: 64-71
        • Al-Busaidi I.S.
        • Clare G.C.
        • Joyce L.R.
        • Pearson S.
        • Lainchbury J.
        • Than M.
        • et al.
        Presentation, treatment and long-term outcomes of a multidisciplinary acute atrial fibrillation pathway: a 12-month follow-up study.
        Heart Lung Circ. 2022; 31: 216-223
        • Stewart S.
        • Ball J.
        • Horowitz J.D.
        • Marwick T.H.
        • Mahadevan G.
        • Wong C.
        • et al.
        Standard versus atrial fibrillation-specific management strategy (SAFETY) to reduce recurrent admission and prolong survival: pragmatic, multicentre, randomised controlled trial.
        Lancet. 2015; 385: 775-784
        • Gallagher C.
        • Hendriks J.M.
        • Nyfort-Hansen K.
        • Sanders P.
        • Lau D.H.
        Integrated care for atrial fibrillation: the heart of the matter.
        Eur J Prev Cardiol. 2020. Nov 6; (Online ahead of print): zwaa065https://doi.org/10.1093/eurjpc/zwaa065
        • Gallagher C.
        • Elliott A.D.
        • Wong C.X.
        • Rangnekar G.
        • Middeldorp M.E.
        • Mahajan R.
        • et al.
        Integrated care in atrial fibrillation: a systematic review and meta-analysis.
        Heart. 2017; 103: 1947-1953
        • Brieger D.
        • Amerena J.
        • Attia J.
        • Bajorek B.
        • Chan K.H.
        • Connell C.
        • et al.
        National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018.
        Heart Lung Circ. 2018; 27: 1209-1266
        • Pathak R.K.
        • Middeldorp M.E.
        • Meredith M.
        • Mehta A.B.
        • Mahajan R.
        • Wong C.X.
        • et al.
        Long-term effect of goal-directed weight management in an atrial fibrillation cohort: a long term follow-up study (LEGACY).
        J Am Coll Cardiol. 2015; 65: 2159-2169
        • Pathak R.K.
        • Evans M.
        • Middeldorp M.E.
        • Mahajan R.
        • Mehta A.B.
        • Meredith M.
        • et al.
        Cost-effectiveness and clinical effectiveness of the risk factor management clinic in atrial fibrillation: the CENT study.
        JACC Clin Electrophysiol. 2017; 3: 436-447
        • Gallagher C.
        • Rowett D.
        • Nyfort-Hansen K.
        • Simmons S.
        • Brooks A.G.
        • Moss J.R.
        • et al.
        Patient-centered educational resources for atrial fibrillation.
        JACC Clin Electrophysiol. 2019; 5: 1101-1114

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