Date of Award

January 2024

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Karthik Murugiah

Abstract

Introduction: Atrial fibrillation (AF) is the most common cardiac arrythmia affecting up to 6 million people in the United States (US). With an aging population and increased detection through self-monitoring devices, AF prevalence will substantially rise in the future. AF often co-exists with other comorbidities and is associated with significant morbidity and healthcare costs. AF management has also been evolving with increased use of anti-arrhythmics, newer anticoagulants, and procedures to maintain sinus rhythm. In this backdrop, our study aims to provide a contemporary national assessment of AF costs using the Medical Expenditure Panel Survey (MEPS), the largest all-payer nationally representative annual cross- sectional survey of medical costs of the US civilian noninstitutionalized population administered by the Agency of Healthcare Research and Quality. Methods: MEPS Full-Year Consolidated Data File and Medical Conditions File data from 2016-2021 were used. Individuals were assigned weights based on demographic proportions in the overall US population. All data are publicly available, and institutional review board approval was not required. AF was defined for adults age 18 years of age or older with International Classification of Disease (ICD)-10 code “I48.” A gamma model with log link estimated the effect of AF on total expenditures with multivariable adjustment. Results: Of a weighted surveyed population of 189,953,502 US adults, 4,207,169 (2.2%) had AF. The mean age of AF individuals was 71.5 ± 10.9 years, 46.1% were female and the median Charlson Comorbidity Index (CCI) was 1 [0-1]. Mean unadjusted annual total healthcare expenditure was $24,429 ± $42,011 (inpatient visits $7,615 ± $29,390, prescriptions $6,076 ± $13,905, and office-based visits $4,737 ± $11,257). The incremental adjusted annual healthcare expenditure attributable to AF was $7,117 per person. After multivariable adjustment, later survey year, modified CCI of ≥2, presence of ASCVD, HF, or cancer, bachelor’s, master, or doctorate degree, and uninsured status were associated with higher expenditure among AF individuals. Conclusion: AF is associated with substantial financial burden related to inpatient, prescriptions, and office-based visits. However, with increased detection and innovative treatments, healthcare costs may decrease in the long term.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 04/30/2026

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