Hospital healthcare utilisation in patients with atrial fibrillation: the role of multimorbidity and age

BACKGROUND: Patients with atrial fibrillation (AF) often present with multimorbidity and may require a higher healthcare utilisation. We aimed to compare hospital healthcare utilisation among AF patients to non-cardiovascular disease (non-CVD) patients and explore the role of multimorbidity and age. METHODS: We performed a retrospective cohort study using electronic health records data from three hospitals in the Netherlands. Patients aged ≥ 18 years with ≥ 1 inpatient or outpatient presentation were included. Diagnoses were determined using the International Classification of Diseases and Related Health Problems 10 codes and linked with the Dutch Hospital Data Clinical Classification Software to determine comorbidities. RESULTS: A total of 226,991 patients, 5,127 (2%) had AF. AF patients had significantly more outpatient visits (6.6 vs 3.6), emergency department visits (0.9 vs 0.2), and in-hospital days (4.0 vs 1.5) compared to non-CVD patients/year (all p < 0.001). AF patients saw more frequently multiple specialists, (13% vs 2% consulting ≥ 5 specialists, p < 0.001). Number of outpatient visits for AF patients increased with number of comorbidities: from a median of 1 (0-1 comorbidities) to 11 (≥ 4 comorbidities) (p < 0.001). Similarly, in-hospital days increased from 0.6 days (0-1 comorbidities) to 8.2 days (≥ 4 comorbidities) (p < 0.001). Regardless of age, AF patients had more outpatient and emergency department visits and more days in hospital days compared to non-CVD patients (all p < 0.001). CONCLUSIONS: Patients with AF had significantly greater hospital healthcare utilisation use compared to non-CVD patients, independent of age. Therefore, there is a need for more cohesive care pathways in AF patients to reduce healthcare utilisation.