186
Letters to the Editor
[9] Ontrup J, Ritter H. Large-scale data exploration with the hierarchically growing hyperbolic SOM. Neural Netw 2006;19:751–61. [10] Hart WE. Locally-adaptive and memetic evolutionary pattern search algorithms. Evol Comput 2003;11:29–51.
[11] Shaw LJ, Marwick TH, Zoghbi WA, et al. Why all the focus on cardiac imaging? JACC Cardiovasc Imaging 2010;3:789–94. [12] Kurt I, Ture M, Kurum AT. Comparing performances of logistic regression, classification and regression tree, and neural networks for predicting coronary artery disease. Expert Syst Appl 2008;34:366–74.
http://dx.doi.org/10.1016/j.ijcard.2014.03.184 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved.
Costs and mortality associated with atrial fibrillation complicated by myocardial infarction in the United States Ranjan Pathak, Paras Karmacharya, Madan Raj Aryal ⁎, Anthony Donato Department of Medicine, Reading Health System, West Reading, PA, USA
a r t i c l e
i n f o
Article history: Received 15 February 2014 Accepted 29 March 2014 Available online 8 April 2014
Table 1 Hospital charge and length of stay in patients having atrial fibrillation (AF) with and without myocardial infarction (MI).
AF Keywords: Atrial fibrillation Myocardial infarction Health care utilization project Hospital charge Length of stay
Letter to the editor: Recently, an interesting bidirectional association between atrial fibrillation (AF) and Myocardial Infarction (MI) has been proposed [1]. This association could have important economic consequences in light of predictions that the number of patients with AF may double by 2050 [2]. While estimates of costs for both conditions are individually wellstudied [3,4], whether these two conditions have additive costs when they occur together is unknown. We searched discharge data from the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality (AHRQ) to quantify the implications of this association in quantitative terms. We compared unadjusted costs, length of stay and mortality in groups with AF with and without MI using z-test to quantify the implications of this association. Nationwide Inpatient Sample Healthcare Cost and Utilization Project is a stratified 20% sample of inpatient admissions across the US community hospitals. It is the largest all-payer inpatient database. We analyzed 458,287 admissions with AF in 2011 using International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) diagnosis codes for AF (427.31) and MI (410.0–410.8). Out of 458,287 admissions for AF, 456,638 patients
⁎ Corresponding author at: 6th Avenue and Spruce Street, West Reading, PA 19611, USA. Tel.: + 1 484 628 8255; fax: +1 484 628 9003. E-mail address: [email protected] (M.R. Aryal).
http://dx.doi.org/10.1016/j.ijcard.2014.03.183 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved.
AF and MI Difference
Hospital charge (USD)
Length of stay (days)
Mortality (per 100 admission)
$29,887.54 (95% CI 27,989.13–31,785.96) $49,260.71 (95% CI 42,732.62–55,788.8) $19,373.17 USD
3.34 (95% CI 3.28–3.4) 7.47 (95% CI 6.79–8.15) 4.13 days
3.15 (95% CI 3.05–3.25) 4.06 (95% CI 3.82–4.33) 1 death
(99.6%) had AF without MI and 1649 patients (0.4%) had AF with MI. The mean hospital charge and length of stay were significantly higher (p b 0.05) in patients with AF and MI compared to AF alone (Table 1). This translated to an excess length of stay of 4.13 days and excess costs of greater than $19,000. The odds of death in patients with AF and MI were higher than patients with AF alone, but were not statistically significant (OR 2.08, 95% CI 0.93–4.66). Both AF and MI share common risk factors that are well established. However, further studies need to be carried out to specifically determine the factors associated with AF which leads to a higher risk of MI. This will aid in risk stratification, risk factor modification and formulation of possible interventions to prevent MI in these subset of AF patients. Disclosures: Authors have no financial disclosure to disclose. References [1] Soliman EZ, Safford MM, Muntner P, et al. Atrial fibrillation and the risk of myocardial infarction. JAMA Intern Med 2014;174(1):107–14. [2] Naccarelli GV, Varker H, Lin J, Schulman KL. Increasing prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol 2009;104(11):1534–9. [3] Schreyögg J, Stargardt T. The trade-off between costs and outcomes: the case of acute myocardial infarction. Health Serv Res 2010;45(6 Pt 1):1585–601. [4] Wolowacz SE, Samuel M, Brennan VK, Jasso-Mosqueda J-G, Van Gelder IC. The cost of illness of atrial fibrillation: a systematic review of the recent literature. Eur Eur Pacing Arrhythm Card Electrophysiol J Work Groups Card Pacing Arrhythm Card Cell Electrophysiol Eur Soc Cardiol 2011;13(10):1375–85.
Letters to the Editor
[9] Ontrup J, Ritter H. Large-scale data exploration with the hierarchically growing hyperbolic SOM. Neural Netw 2006;19:751–61. [10] Hart WE. Locally-adaptive and memetic evolutionary pattern search algorithms. Evol Comput 2003;11:29–51.
[11] Shaw LJ, Marwick TH, Zoghbi WA, et al. Why all the focus on cardiac imaging? JACC Cardiovasc Imaging 2010;3:789–94. [12] Kurt I, Ture M, Kurum AT. Comparing performances of logistic regression, classification and regression tree, and neural networks for predicting coronary artery disease. Expert Syst Appl 2008;34:366–74.
http://dx.doi.org/10.1016/j.ijcard.2014.03.184 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved.
Costs and mortality associated with atrial fibrillation complicated by myocardial infarction in the United States Ranjan Pathak, Paras Karmacharya, Madan Raj Aryal ⁎, Anthony Donato Department of Medicine, Reading Health System, West Reading, PA, USA
a r t i c l e
i n f o
Article history: Received 15 February 2014 Accepted 29 March 2014 Available online 8 April 2014
Table 1 Hospital charge and length of stay in patients having atrial fibrillation (AF) with and without myocardial infarction (MI).
AF Keywords: Atrial fibrillation Myocardial infarction Health care utilization project Hospital charge Length of stay
Letter to the editor: Recently, an interesting bidirectional association between atrial fibrillation (AF) and Myocardial Infarction (MI) has been proposed [1]. This association could have important economic consequences in light of predictions that the number of patients with AF may double by 2050 [2]. While estimates of costs for both conditions are individually wellstudied [3,4], whether these two conditions have additive costs when they occur together is unknown. We searched discharge data from the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality (AHRQ) to quantify the implications of this association in quantitative terms. We compared unadjusted costs, length of stay and mortality in groups with AF with and without MI using z-test to quantify the implications of this association. Nationwide Inpatient Sample Healthcare Cost and Utilization Project is a stratified 20% sample of inpatient admissions across the US community hospitals. It is the largest all-payer inpatient database. We analyzed 458,287 admissions with AF in 2011 using International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) diagnosis codes for AF (427.31) and MI (410.0–410.8). Out of 458,287 admissions for AF, 456,638 patients
⁎ Corresponding author at: 6th Avenue and Spruce Street, West Reading, PA 19611, USA. Tel.: + 1 484 628 8255; fax: +1 484 628 9003. E-mail address: [email protected] (M.R. Aryal).
http://dx.doi.org/10.1016/j.ijcard.2014.03.183 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved.
AF and MI Difference
Hospital charge (USD)
Length of stay (days)
Mortality (per 100 admission)
$29,887.54 (95% CI 27,989.13–31,785.96) $49,260.71 (95% CI 42,732.62–55,788.8) $19,373.17 USD
3.34 (95% CI 3.28–3.4) 7.47 (95% CI 6.79–8.15) 4.13 days
3.15 (95% CI 3.05–3.25) 4.06 (95% CI 3.82–4.33) 1 death
(99.6%) had AF without MI and 1649 patients (0.4%) had AF with MI. The mean hospital charge and length of stay were significantly higher (p b 0.05) in patients with AF and MI compared to AF alone (Table 1). This translated to an excess length of stay of 4.13 days and excess costs of greater than $19,000. The odds of death in patients with AF and MI were higher than patients with AF alone, but were not statistically significant (OR 2.08, 95% CI 0.93–4.66). Both AF and MI share common risk factors that are well established. However, further studies need to be carried out to specifically determine the factors associated with AF which leads to a higher risk of MI. This will aid in risk stratification, risk factor modification and formulation of possible interventions to prevent MI in these subset of AF patients. Disclosures: Authors have no financial disclosure to disclose. References [1] Soliman EZ, Safford MM, Muntner P, et al. Atrial fibrillation and the risk of myocardial infarction. JAMA Intern Med 2014;174(1):107–14. [2] Naccarelli GV, Varker H, Lin J, Schulman KL. Increasing prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol 2009;104(11):1534–9. [3] Schreyögg J, Stargardt T. The trade-off between costs and outcomes: the case of acute myocardial infarction. Health Serv Res 2010;45(6 Pt 1):1585–601. [4] Wolowacz SE, Samuel M, Brennan VK, Jasso-Mosqueda J-G, Van Gelder IC. The cost of illness of atrial fibrillation: a systematic review of the recent literature. Eur Eur Pacing Arrhythm Card Electrophysiol J Work Groups Card Pacing Arrhythm Card Cell Electrophysiol Eur Soc Cardiol 2011;13(10):1375–85.
