Prescription Medication Use and Expenditure for Atrial Fibrillation in the United States

Objectives

To study the national trends of anticoagulants, antiarrhythmic drugs (AADs), and expenditures in the civilian noninstitutionalized atrial fibrillation (AF) population.

Methods

The Medical Expenditure Panel Survey was queried from January 2016 to December 2021 to identify adults (age ≥18 years) with a diagnosis of AF utilizing the International Classification of Diseases, Tenth Revision, Clinical Modification code I48. Prevalence of anticoagulants (AAD) and its expenditure and AF expenditure across clinical settings in the United States were estimated. The predictors of anticoagulant use were identified utilizing multivariate logistic regression analysis.

Results

A total of 17.3 million AF adults were identified, of which 46.5% were female, 89.6% were White, and ∼70% were middle/high income with prevalent comorbidities of hypertension (75.3%) and coronary heart disease (30%). The mean CHA₂DS₂ VASc score was 3.2, and 40% had a score of ≥4. In the United States, an average of $26 103 (2021 inflation adjusted) was spent per year per adult with AF for health-related expenditures. The prevalence of direct oral anticoagulants (DOACs) and class I AAD use has increased; in contrast, vitamin K antagonists use has declined. DOAC-related per person annual expenses increased from $849 in 2016 to $1929 in 2021. In those with a CHA₂DS₂ VASc score of ≥2, female sex and the presence of coronary heart disease were associated with a lower likelihood of anticoagulant use.

Conclusions

AF is a costly condition in which prescription medication use, such as DOACs and class III AADs, are significant contributors.