Hospitalisation and healthcare utilisation in participants screened for atrial fibrillation

Background

Screening for atrial fibrillation (AF) may impact healthcare usage and risk of hospitalisation, however this is unknown.

Purpose

We investigated the healthcare use and risk of hospitalisation associated with long-term, continuous screening for AF compared with usual care in a randomised clinical trial.

Methods

This was a post-hoc analysis of the randomised LOOP study (Atrial Fibrillation Detected by Continuous ECG Monitoring Using Implantable Loop Recorder to Prevent Stroke in High-risk Individuals), randomising >70-year-olds with stroke risk factors to implantable loop recorder (ILR) screening for AF vs usual care. In this study, all general practitioner (GP) consultations, outpatient clinic visits, and hospitalisations were collected using Danish nationwide health registries. Incidence rates and adjusted cumulative incidences and adjusted hazard ratios (aHRs) were estimated for all-cause contacts, whereas outpatient visits and hospitalisations were further stratified by AF, other cardiovascular, or no/unknown diagnosis as the cause of contact. Contacts as part of the study protocol (e.g. ILR implantation) were omitted from the analyses.

Results

Among 6,004 participants, 5,329 (89%) survived until the end of follow-up (median 6.4 (6.0;6.8) years). During this period, 5,992 participants had 262,472 all-cause GP consultations, 5,872 participants had 96,879 all-cause outpatient visits, and 4,345 participants had 19,139 all-cause hospitalisations.

The screening group had higher overall incidence rates for GP consultation and outpatient visits (6.58 (6.53;6.64) vs 6.27 (6.24;6.30) and 2.69 (2.66;2.72) vs 2.63 (2.61;65), respectively) but not for hospitalisation (0.51 (0.50;0.53) vs 0.51 (0.50; 0.52) events per person-year, Figure 1), and shorter time to first GP consultation (aHR 1.11 (1.05;1.18)), all-cause outpatient visit (aHR 1.14 (1.07;1.21)), AF outpatient visit (aHR 5.30 (4.07;6.90)), and AF hospitalisation (aHR 1.90 (1.44;2.49)), but similar for all-cause hospitalisation (aHR 1.03 (0.97;1.11)), and the risk of hospitalisation with other cardiovascular diagnosis was lower in the screening group than usual care (aHR 0.87 (0.77;0.99)). Table 1 shows absolute risk for first contact and aHR for screening vs usual care.

Overall, male participants had a higher risk of all-cause hospitalisation (aHR 1.11 (1.04;1.18), but a lower risk of all-cause outpatient visit (aHR 0.93 (0.88;0.97)) and GP consultations (aHR 0.90 (0.86;0.95)), which was similar when grouped by randomisation group.

Conclusion

Long-term, continuous screening for AF was associated with higher rates and risk of GP consultation, outpatient visits and AF hospitalisation compared to usual care, while all-cause hospitalisations were similar and hospitalisation for non-AF cardiovascular diagnosis was lower in the screening group. Further, males had higher risk of hospitalisation and lower risk of GP consultations and outpatient visits than females.