Left atrial appendage closure with the watchman device reduces atrial fibrillation management costs

Aims To report hospitalization costs of patients with non-valvular atrial fibrillation (AF) submitted to percutaneous left atrial appendage closure (LAAC) with the Watchman device. Methods Pre- and post-procedural hospitalization AF-related costs were calculated using the DRG system (diagnosis-relat...

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Published inClinical research in cardiology Vol. 111; no. 1; pp. 105 - 113
Main Authors D´Ancona, Giuseppe, Safak, Erdal, Weber, Denise, Arslan, Fatih, Kische, Stephan, Darius, Harald, Behrens, Steffen, Zohlenhöfer-Momm, Dietlind, Ortak, Jasmin, Kugler, Joachim, Ince, Hüseyin
Format Journal Article
LanguageEnglish
Published Berlin/Heidelberg Springer Berlin Heidelberg 01.01.2022
Springer Nature B.V
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ISSN1861-0684
1861-0692
1861-0692
DOI10.1007/s00392-021-01943-7

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Abstract Aims To report hospitalization costs of patients with non-valvular atrial fibrillation (AF) submitted to percutaneous left atrial appendage closure (LAAC) with the Watchman device. Methods Pre- and post-procedural hospitalization AF-related costs were calculated using the DRG system (diagnosis-related groups) and compared. Results Between 2012 and 2016, 677 non-valvular AF patients underwent LAAC. Median time from first cardiac hospitalization to LAAC was 5.9 years (IQR 1.6–9.1) and median follow-up after LAAC was 4.8 years (IQR 3.6–5.6). LAAC mortality was 1.3% and follow-up mortality 16.9%. Median pre-LAAC hospitalization cost was € 17,867 (IQR € 7512–35,08) and post-LAAC € 8772 (IQR € 1183–25,159) ( p  < 0.0001). Annualized cost pre-LAAC was 3773 € (IQR € 1644–8,493) and post-LAAC 2,001 € (IQR € 260–6913) ( p  < 0.0001). Follow-up survivors had significantly lower post-LAAC costs ( p  < 0.0001) and after a survival cut-off time of 4.6 years LAAC procedural and post-procedural hospitalization costs achieved parity with pre-LACC costs (AUC 0.64; p  = 0.02). CHA2DS2-VASc score ( B  = 0.04; p  = 0.02; 95% CI 0.006–0.08), and HAS-BLED score ( B  = 0.08; p  = 0.004; 95% CI 0.02–0.14) were independent determinants for annualized hospitalization costs post-LAAC. At Cox-regression analysis the DRG mean clinical complexity level (CCL) was the only independent determinant for follow-up mortality (OR = 2.2; p  < 0.0001; 95% CI 1.6–2.8) with a cut-off value of 2.25 to predict follow-up mortality (AUC 0.72; p  < 0.0001; Spec. 70%; Sens. 70%). Conclusion Hospitalization costs pre-LAAC are consistent, and after LAAC, they are significantly reduced. Costs seem related to the patient's risk profile at the time of the procedure. With the increase in post-LAAC survival time, the procedure becomes economically more profitable. Graphic abstract
AbstractList To report hospitalization costs of patients with non-valvular atrial fibrillation (AF) submitted to percutaneous left atrial appendage closure (LAAC) with the Watchman device.AIMSTo report hospitalization costs of patients with non-valvular atrial fibrillation (AF) submitted to percutaneous left atrial appendage closure (LAAC) with the Watchman device.Pre- and post-procedural hospitalization AF-related costs were calculated using the DRG system (diagnosis-related groups) and compared.METHODSPre- and post-procedural hospitalization AF-related costs were calculated using the DRG system (diagnosis-related groups) and compared.Between 2012 and 2016, 677 non-valvular AF patients underwent LAAC. Median time from first cardiac hospitalization to LAAC was 5.9 years (IQR 1.6-9.1) and median follow-up after LAAC was 4.8 years (IQR 3.6-5.6). LAAC mortality was 1.3% and follow-up mortality 16.9%. Median pre-LAAC hospitalization cost was € 17,867 (IQR € 7512-35,08) and post-LAAC € 8772 (IQR € 1183-25,159) (p < 0.0001). Annualized cost pre-LAAC was 3773 € (IQR € 1644-8,493) and post-LAAC 2,001 € (IQR € 260-6913) (p < 0.0001). Follow-up survivors had significantly lower post-LAAC costs (p < 0.0001) and after a survival cut-off time of 4.6 years LAAC procedural and post-procedural hospitalization costs achieved parity with pre-LACC costs (AUC 0.64; p = 0.02). CHA2DS2-VASc score (B = 0.04; p = 0.02; 95% CI 0.006-0.08), and HAS-BLED score (B = 0.08; p = 0.004; 95% CI 0.02-0.14) were independent determinants for annualized hospitalization costs post-LAAC. At Cox-regression analysis the DRG mean clinical complexity level (CCL) was the only independent determinant for follow-up mortality (OR = 2.2; p < 0.0001; 95% CI 1.6-2.8) with a cut-off value of 2.25 to predict follow-up mortality (AUC 0.72; p < 0.0001; Spec. 70%; Sens. 70%).RESULTSBetween 2012 and 2016, 677 non-valvular AF patients underwent LAAC. Median time from first cardiac hospitalization to LAAC was 5.9 years (IQR 1.6-9.1) and median follow-up after LAAC was 4.8 years (IQR 3.6-5.6). LAAC mortality was 1.3% and follow-up mortality 16.9%. Median pre-LAAC hospitalization cost was € 17,867 (IQR € 7512-35,08) and post-LAAC € 8772 (IQR € 1183-25,159) (p < 0.0001). Annualized cost pre-LAAC was 3773 € (IQR € 1644-8,493) and post-LAAC 2,001 € (IQR € 260-6913) (p < 0.0001). Follow-up survivors had significantly lower post-LAAC costs (p < 0.0001) and after a survival cut-off time of 4.6 years LAAC procedural and post-procedural hospitalization costs achieved parity with pre-LACC costs (AUC 0.64; p = 0.02). CHA2DS2-VASc score (B = 0.04; p = 0.02; 95% CI 0.006-0.08), and HAS-BLED score (B = 0.08; p = 0.004; 95% CI 0.02-0.14) were independent determinants for annualized hospitalization costs post-LAAC. At Cox-regression analysis the DRG mean clinical complexity level (CCL) was the only independent determinant for follow-up mortality (OR = 2.2; p < 0.0001; 95% CI 1.6-2.8) with a cut-off value of 2.25 to predict follow-up mortality (AUC 0.72; p < 0.0001; Spec. 70%; Sens. 70%).Hospitalization costs pre-LAAC are consistent, and after LAAC, they are significantly reduced. Costs seem related to the patient's risk profile at the time of the procedure. With the increase in post-LAAC survival time, the procedure becomes economically more profitable.CONCLUSIONHospitalization costs pre-LAAC are consistent, and after LAAC, they are significantly reduced. Costs seem related to the patient's risk profile at the time of the procedure. With the increase in post-LAAC survival time, the procedure becomes economically more profitable.
Aims To report hospitalization costs of patients with non-valvular atrial fibrillation (AF) submitted to percutaneous left atrial appendage closure (LAAC) with the Watchman device. Methods Pre- and post-procedural hospitalization AF-related costs were calculated using the DRG system (diagnosis-related groups) and compared. Results Between 2012 and 2016, 677 non-valvular AF patients underwent LAAC. Median time from first cardiac hospitalization to LAAC was 5.9 years (IQR 1.6–9.1) and median follow-up after LAAC was 4.8 years (IQR 3.6–5.6). LAAC mortality was 1.3% and follow-up mortality 16.9%. Median pre-LAAC hospitalization cost was € 17,867 (IQR € 7512–35,08) and post-LAAC € 8772 (IQR € 1183–25,159) ( p  < 0.0001). Annualized cost pre-LAAC was 3773 € (IQR € 1644–8,493) and post-LAAC 2,001 € (IQR € 260–6913) ( p  < 0.0001). Follow-up survivors had significantly lower post-LAAC costs ( p  < 0.0001) and after a survival cut-off time of 4.6 years LAAC procedural and post-procedural hospitalization costs achieved parity with pre-LACC costs (AUC 0.64; p  = 0.02). CHA2DS2-VASc score ( B  = 0.04; p  = 0.02; 95% CI 0.006–0.08), and HAS-BLED score ( B  = 0.08; p  = 0.004; 95% CI 0.02–0.14) were independent determinants for annualized hospitalization costs post-LAAC. At Cox-regression analysis the DRG mean clinical complexity level (CCL) was the only independent determinant for follow-up mortality (OR = 2.2; p  < 0.0001; 95% CI 1.6–2.8) with a cut-off value of 2.25 to predict follow-up mortality (AUC 0.72; p  < 0.0001; Spec. 70%; Sens. 70%). Conclusion Hospitalization costs pre-LAAC are consistent, and after LAAC, they are significantly reduced. Costs seem related to the patient's risk profile at the time of the procedure. With the increase in post-LAAC survival time, the procedure becomes economically more profitable. Graphic abstract
AimsTo report hospitalization costs of patients with non-valvular atrial fibrillation (AF) submitted to percutaneous left atrial appendage closure (LAAC) with the Watchman device.MethodsPre- and post-procedural hospitalization AF-related costs were calculated using the DRG system (diagnosis-related groups) and compared.ResultsBetween 2012 and 2016, 677 non-valvular AF patients underwent LAAC. Median time from first cardiac hospitalization to LAAC was 5.9 years (IQR 1.6–9.1) and median follow-up after LAAC was 4.8 years (IQR 3.6–5.6). LAAC mortality was 1.3% and follow-up mortality 16.9%. Median pre-LAAC hospitalization cost was € 17,867 (IQR € 7512–35,08) and post-LAAC € 8772 (IQR € 1183–25,159) (p < 0.0001). Annualized cost pre-LAAC was 3773 € (IQR € 1644–8,493) and post-LAAC 2,001 € (IQR € 260–6913) (p < 0.0001). Follow-up survivors had significantly lower post-LAAC costs (p < 0.0001) and after a survival cut-off time of 4.6 years LAAC procedural and post-procedural hospitalization costs achieved parity with pre-LACC costs (AUC 0.64; p = 0.02). CHA2DS2-VASc score (B = 0.04; p = 0.02; 95% CI 0.006–0.08), and HAS-BLED score (B = 0.08; p = 0.004; 95% CI 0.02–0.14) were independent determinants for annualized hospitalization costs post-LAAC. At Cox-regression analysis the DRG mean clinical complexity level (CCL) was the only independent determinant for follow-up mortality (OR = 2.2; p < 0.0001; 95% CI 1.6–2.8) with a cut-off value of 2.25 to predict follow-up mortality (AUC 0.72; p < 0.0001; Spec. 70%; Sens. 70%).ConclusionHospitalization costs pre-LAAC are consistent, and after LAAC, they are significantly reduced. Costs seem related to the patient's risk profile at the time of the procedure. With the increase in post-LAAC survival time, the procedure becomes economically more profitable.Graphic abstract
To report hospitalization costs of patients with non-valvular atrial fibrillation (AF) submitted to percutaneous left atrial appendage closure (LAAC) with the Watchman device. Pre- and post-procedural hospitalization AF-related costs were calculated using the DRG system (diagnosis-related groups) and compared. Between 2012 and 2016, 677 non-valvular AF patients underwent LAAC. Median time from first cardiac hospitalization to LAAC was 5.9 years (IQR 1.6-9.1) and median follow-up after LAAC was 4.8 years (IQR 3.6-5.6). LAAC mortality was 1.3% and follow-up mortality 16.9%. Median pre-LAAC hospitalization cost was € 17,867 (IQR € 7512-35,08) and post-LAAC € 8772 (IQR € 1183-25,159) (p < 0.0001). Annualized cost pre-LAAC was 3773 € (IQR € 1644-8,493) and post-LAAC 2,001 € (IQR € 260-6913) (p < 0.0001). Follow-up survivors had significantly lower post-LAAC costs (p < 0.0001) and after a survival cut-off time of 4.6 years LAAC procedural and post-procedural hospitalization costs achieved parity with pre-LACC costs (AUC 0.64; p = 0.02). CHA2DS2-VASc score (B = 0.04; p = 0.02; 95% CI 0.006-0.08), and HAS-BLED score (B = 0.08; p = 0.004; 95% CI 0.02-0.14) were independent determinants for annualized hospitalization costs post-LAAC. At Cox-regression analysis the DRG mean clinical complexity level (CCL) was the only independent determinant for follow-up mortality (OR = 2.2; p < 0.0001; 95% CI 1.6-2.8) with a cut-off value of 2.25 to predict follow-up mortality (AUC 0.72; p < 0.0001; Spec. 70%; Sens. 70%). Hospitalization costs pre-LAAC are consistent, and after LAAC, they are significantly reduced. Costs seem related to the patient's risk profile at the time of the procedure. With the increase in post-LAAC survival time, the procedure becomes economically more profitable.
Author Arslan, Fatih
Safak, Erdal
Ince, Hüseyin
Weber, Denise
Kugler, Joachim
Behrens, Steffen
D´Ancona, Giuseppe
Darius, Harald
Zohlenhöfer-Momm, Dietlind
Ortak, Jasmin
Kische, Stephan
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  organization: Department of Cardiology, Vivantes Klinikum Am Urban and Im Friedrichshain, Rostock University
BackLink https://www.ncbi.nlm.nih.gov/pubmed/34652527$$D View this record in MEDLINE/PubMed
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CitedBy_id crossref_primary_10_1002_clc_24122
crossref_primary_10_1016_j_ijcard_2021_09_052
crossref_primary_10_1007_s12471_022_01675_x
crossref_primary_10_1007_s00392_023_02299_w
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2021. Springer-Verlag GmbH Germany, part of Springer Nature.
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Issue 1
Keywords Occlusion
Appendage
Costs
Fibrillation
Percutaneous
Atrial
Factors
DRG
Risk
Language English
License 2021. Springer-Verlag GmbH Germany, part of Springer Nature.
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PublicationTitle Clinical research in cardiology
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Springer Nature B.V
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VWY Lee (1943_CR9) 2016; 16
VY Reddy (1943_CR10) 2015; 66
AS Go (1943_CR1) 2001; 285
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Snippet Aims To report hospitalization costs of patients with non-valvular atrial fibrillation (AF) submitted to percutaneous left atrial appendage closure (LAAC) with...
To report hospitalization costs of patients with non-valvular atrial fibrillation (AF) submitted to percutaneous left atrial appendage closure (LAAC) with the...
AimsTo report hospitalization costs of patients with non-valvular atrial fibrillation (AF) submitted to percutaneous left atrial appendage closure (LAAC) with...
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StartPage 105
SubjectTerms Aged
Atrial Appendage - surgery
Atrial Fibrillation - mortality
Atrial Fibrillation - surgery
Cardiac arrhythmia
Cardiac Catheterization
Cardiology
Cost analysis
Costs
Costs and Cost Analysis
Female
Fibrillation
Germany
Hospitalization
Hospitalization - economics
Humans
Male
Medicine
Medicine & Public Health
Mortality
Original Paper
Patients
Prostheses and Implants - economics
Regression analysis
Risk assessment
Survival
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Title Left atrial appendage closure with the watchman device reduces atrial fibrillation management costs
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