Temporal pattern and costs of rehospitalization in atrial fibrillation/atrial flutter patients with one or more additional risk factors

Abstract

Objectives:

The ATHENA study showed that use of dronedarone reduced rates of first cardiovascular (CV) hospitalization in atrial fibrillation/flutter (AF/AFL) patients. AF is associated with high costs to payers, which are driven by high rates of hospitalization. This retrospective cohort study examined readmission patterns and costs to US payers in real-world AF/AFL patients with ≥1 additional risk factor (ARF).

Methods:

Patients hospitalized (January 2005–March 2008) with AF/AFL as primary diagnosis and having ≥1 year of health coverage, before and after their first (index) admission, were identified in the PharMetrics Patient-Centric database. As in the ATHENA study, patients had to be ≥75 years of age or ≥70 years, with ≥1 ARF. Rehospitalization patterns (all-cause, all CV-related [including AF/AFL] and AF/AFL-related alone) were examined over 1 year post-index, and costs of index vs later AF/AFL admissions compared.

Results:

The study included 3498 patients (mean 80 [SD 7.6] years; 42.4% men). Over 1 year, 1389 patients (39.7%) were rehospitalized for any cause (mean 1.7 [SD 1.3] events/patient), with 1223 patients (35.0%) undergoing CV-related (mean 1.6 [SD 1.0] events/patient) and 935 (26.7%) undergoing AF-related rehospitalization (mean 1.4 [SD 0.8] events/patient). Common causes of CV-related readmissions (primary diagnosis) were AF/AFL (47.5%), congestive heart failure (CHF) (9.9%), coronary artery disease (7.4%), and stroke/transient ischemic attack (6.2%). Readmission rates at 3 months were 16.2% (all-cause), 14.3% (all CV-related including AF/AFL), and 10.5% (AF/AFL-related alone). AF/AFL readmissions (primary diagnosis) were longer than initial hospitalizations (mean total 6.9 [SD 12.9] vs 4.3 [SD 5.1] days, p?<?0.0001) and more costly (median $1819 [25th percentile $1066, 75th percentile $5623] vs $1707 [25th percentile $1102, 75th percentile $4749]).

Limitations:

This study excluded patients with pre-existing CHF, did not require electrocardiogram confirmation of AF/AFL diagnosis, and did not distinguish between paroxysmal, persistent, and permanent AF.

Conclusions:

AF/AFL patients with ≥1 ARF have high readmission rates. AF/AFL-related readmissions incur higher costs than the initial AF/AFL admissions.     

中小企业过桥资金的融资安排：政府抑或市场

摘要：为缓解中小企业旺盛的过桥资金需求，山东省许多小额贷款公司和担保公司依靠特殊的行业禀赋、股东结构和信息对称的比较优势，成为中小企业过桥资金的提供者。本文经过调研分析认为，应为中小企业设计市场主导的过桥资金融资，在业务透明化、公开化基础上给予合理监管和防范风险。     

热喷涂铝防腐技术在钢管拱桥中的应用

那莫大桥为南宁至百色高速公路K22＋583处跨越右江的一座特大型中承式钢管混凝土拱桥，文章以该大桥为例，说明了热喷涂铝防腐技术在钢管拱桥中的应用。     

先简支后连续桥梁湿接缝的施工技术研究

论述先简支后连续梁的受力特点，详细介绍了湿接缝的施工过程、施工工艺和施工技术指标控制，以期为同类工程施工提供参考。     

大跨径钢桥面铺装体系的研究

大跨径钢桥面铺装是建设桥梁行车体系的关键步骤之一。本文通过分析桥面铺装的力学特性,并采用ANSYS软件对其进行有限元分析,可为以后的研究作为参考,具有一定的使用价值。     

如何提高羔羊的成活率

文章从妊娠母羊的管理、环境卫生、羔羊的管理三方面详细地阐述了如何提高羔羊对疾病的抵抗力、降低羔羊的死亡率。     

由重拍《红楼梦》看经典名著在当下的文化传承

近年来,由古典名著改编的影视剧重拍热兴起,纷纷由老版本跨向新世纪,给人以耳目一新的视听感受,其中以《红楼梦》的重拍影响最甚,这无疑是用当下最现代的传播媒介来传承古典文化。以《红楼梦》的重拍为例,通过其产生的原因及效果来探讨重拍古典名著对当下文化传承的价值和意义。     

桥梁工程施工病害防治及其施工现场质量管理初探

桥梁工程作为贯穿整个公路建设的必不可少的一环,也备受人们的关注。为了保证桥梁工程的质量,对整个施工过程进行质量管理,并实时对桥梁建设工程进行病害检查及病害的防治更是显得尤为重要。本文就桥梁建设工程中的施工病害防治及其现场质量管理等方面进行简述。     

公路桥梁施工的质量监督及其控制

本文对道路桥梁施工质量监督的重要性展开讨论,提高人们对道路桥梁施工质量监督管理工作的重视程度,从而做出更好的改善。