Prevention and education efforts must be pursued to curb the trend, says senior author George A. Mensah, M.D., chief of the cardiovascular health programs at the Centers for Disease Control and Prevention, Atlanta, and co-author of the study.
Among people age 35 and older, the number of hospitalizations in which atrial fibrillation was listed as the first diagnosis increased 144 percent from 154,086 in 1985 to 376,487 in 1999, according to the analysis of hospital discharge records. Moreover, the total number of hospitalizations in which atrial fibrillation was listed as a diagnosis jumped 190 percent from 787,750 to almost 2.3 million in the same 15-year period.
Current predictions are for atrial fibrillation-related hospitalizations to climb to more than 3.3 million by 2025, Mensah notes. Atrial fibrillation (AF) is the loss of organized and coordinated contractions between the chambers of the heart – atria (upper) and ventricles (lower). The atria quiver instead of beating or contracting effectively. Thus, blood isn't pumped completely out of them, so it may pool and clot. A clot that leaves the heart and blocks an artery in the brain causes stroke. Hypertension, congestive heart failure, diabetes and previous heart attack also increase the risk for AF.
Some AF hospitalizations are for procedures used to convert AF to normal rhythm, which might explain a small percentage of the increased hospitalizations, Mensah says.
In addition, the risk for AF increases with age so hospitalization rates rise with the aging population.
Mensah and colleagues searched the National Hospital Discharge Surgery to identify AF associated hospitalizations that occurred in people age 35 or older. They found that more than half of the AF hospitalizations occurred in people aged 75 or older. This is especially significant because in addition to an increased number of AF hospitalizations, there was also a dramatic increase in the number of discharges to nursing homes, he says.
"The adverse trend in hospitalization for AF in the context of an aging population and associated prevalence of congestive heart failure presages a staggering burden on the Medicare system and the quality of life for affected persons," the authors write.
"The real message here is about prevention," Mensah says. "We need to concentrate our efforts on measures that will reduce these hospitalizations and the need for long-term care for these patients."
AF is associated with high blood pressure, stroke, ischemic heart disease, diabetes and congestive heart failure, so prevention efforts should target these conditions, he says.
"We think there is a need for more aggressive attention to addressing risk factors in women – especially a focus on high blood pressure – because we found that women are hospitalized more than men and because women live longer than men," Mensah says. He also notes that compliance with instructions on the use of medications to control heart rhythm and heart rate among atrial fibrillation patients can help reduce hospitalizations and complications.
Co-authors are Wendy A. Wattingney and Janet B. Croft, Ph.D.
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