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August 14, 2026European Heart Journal3 citationsOpen Access

P2889The economic burden attributable to atrial fibrillation in nine European countries: perspectives from the GARFIELD-AF registry

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PCPaolo CozzolinoGAGiuseppe AmbrosioJBJean‐Pierre Bassand

Key Result

Atrial fibrillation imposed the highest annual direct costs per patient in Belgium (€3473) and the UK (€2712), with inpatient care accounting for 48-71% of total costs across European countries.

Key Points

  • To assess the direct healthcare costs and economic burden associated with atrial fibrillation across nine European nations using real-world registry data.
  • Analyzed data from the prospective GARFIELD-AF registry comprising 20,074 adults with newly diagnosed (<6 weeks) atrial fibrillation and ≥1 stroke risk factor followed for a median of 1.97 years (42,435 person-years).
  • Calculated total annual direct costs—including outpatient visits, medications, diagnostic tests, and hospital admissions—using the Bang and Tsiatis method to account for censored cost data.
  • Annual costs per patient were highest in Belgium (€3,473) and the UK (€2,712), while Poland exhibited the lowest absolute per-patient cost but the highest cost relative to national healthcare expenditure per capita (105%).
  • Inpatient admissions represented the primary cost driver across all assessed countries, comprising between 48% (France and Sweden) and 71% (Belgium and Germany) of total direct expenditures, compared to 7% to 32% for outpatient care.

Study Design

Type

Observational (n=20,074)

Multicenter

Yes

Structured PICO

P
Population
20,074 adults with newly diagnosed atrial fibrillation and ≥1 stroke risk factor across 9 European countries, followed for a median of 1.97 years.
O
Outcome
Total annual direct costs due to AF (sum of medical visits, drug therapy, hospital admissions, diagnostic procedures, and other medical events)

Inpatient care is the primary driver of the substantial economic burden of atrial fibrillation across European countries.

Abstract

Background: We evaluated the economic burden of atrial fibrillation (AF) in nine European countries (Belgium, France, Germany, Italy, Netherlands, Poland, Spain, Sweden and UK). Methods: Data were gathered from GARFIELD–AF, a prospective, global registry of adults with newly (<6 weeks) diagnosed AF and ≥1 stroke risk factor(s). Total annual direct costs due to AF were the sum costs of: medical visits, drug therapy, hospital admissions, diagnostic procedures, and other medical events due to AF. Direct unit costs were quantified based on days on drug therapy and events recorded in GARFIELD-AF. Varying lengths of follow-up were considered using Bang and Tsiatis method to handle censored cost data. Mean cost per patient/year was expressed as absolute cost (€) and as a percentage of the country-specific healthcare expenditure per capita. Results: Data were collated from 20,074 patients; median follow-up 1.97 years and 42,435 person-years of observations. Highest expenditure was observed in Belgium and UK (€ 3473 and € 2712, respectively); Table 1. Poland, with the smallest total cost per patient/year, had the highest healthcare expenditure per capita (105%). Inpatient care was the main cost in all countries, ranging between 48% of the total costs (France and Sweden) and 71% (Belgium and Germany); Fig.1. Outpatient costs varied between 7% of the total cost (Poland) and 32% (Netherlands). Different treatment combinations are likely to be responsible for variations in drug treatment costs.

Expert Takes3 quotes

1/3

“We are excited to have a strong presence at this year's ESC Congress, as a result of the wealth of new GARFIELD-AF data, which will be presented by some of the leading investigators involved in the registry.”

Ajay K. Kakkar, Professor of Surgery, University College LondonUniversity College London / Thrombosis Research Instituteauto_pipelineSupportiveView source
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Cite This Study

Cozzolino et al. (2018) conducted an observational in Atrial fibrillation (n=20,074). Atrial fibrillation was evaluated on Total annual direct costs due to AF. Atrial fibrillation imposed the highest annual direct costs per patient in Belgium (€3473) and the UK (€2712), with inpatient care accounting for 48-71% of total costs across European countries.

synapsesocial.com/papers/6a7ea9aaec5eed42c5a78d02https://doi.org/10.1093/eurheartj/ehy565.p2889
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