The Cost of Atrial Fibrillation: A Systematic Review

Objectives: Atrial fibrillation (AF) is the most common cardiac arrhythmia, with an increasing incidence and prevalence due to progressively ageing populations. Costs related to AF are both direct and indirect. This systematic review aims to identify the main cost drivers of the illness, assess the potential economic impact resulting from changes in care strategies and propose interventions where they are most needed. Methods: A systematic literature search of the PubMed and Scopus databases was performed to identify analytical observational studies defining the cost of illness in cases of AF. The search strategy was based on the PRISMA 2020 recommendations. Results: Of the 944 articles retrieved, 24 met the inclusion criteria. These studies were conducted in several countries. All studies calculated the direct medical costs, while 8 out of 24 studies assessed indirect costs. The median annual direct medical cost per patient, considering all studies, was €9,409 (13,333 US dollars in purchasing power parities), with a very large variability due to the heterogeneity of different analyses. Hospitalisation costs are generally the main cost drivers. Comorbidities and complications, such as stroke, considerably increase the average annual direct medical cost of AF. Conclusions: In most of the analysed studies, inpatient care cost represents the main component of the mean direct medical cost per patient. Stroke and heart failure are responsible for a large share of the total costs; therefore, implementing guidelines to manage comorbidities in AF is a necessary step to improve health and mitigate healthcare costs.