Patient Clusters and Cost Trajectories in Atrial Fibrillation: Evidence from the Swiss Atrial Fibrillation Cohort

Aims Evidence on long-term costs of atrial fibrillation (AF) and associated factors is scarce. As part of the Swiss-AF prospective cohort study we aimed to characterise AF costs and their development over time, and to assess specific patient clusters and their cost trajectories. Methods Swiss-AF enrolled 2,415 patients with variable duration of AF between 2014 and 2017. Patient clusters were identified using hierarchical cluster analysis of baseline characteristics. Ongoing yearly follow-ups include health insurance clinical and claims data. An algorithm was developed to adjudicate costs to AF and related complications. Results Hierarchical analysis identified three patient clusters. “Cardiovascular-dominated” (CV-dominated) patients had the highest proportions of prior myocardial infarction and presence of diabetes. “Heart failure-dominated” (HF-dominated) patients had the highest occurrence of heart failure and permanent AF. “Isolated symptomatic” (IS) patients were younger and had the highest occurrence of paroxysmal AF. A subpopulation of 1,024 Swiss-AF patients with available claims data was followed up for a median [interquartile range] of 3.24 [1.09] years. Average yearly AF-adjudicated costs amounted to CHF 5,679, remaining stable across the observation period. CV-dominated (N = 253 with claims data) and HF-dominated patients (N = 185) depicted similarly high costs across all cost outcomes, the IS (N = 586) patients accrued the lowest costs. Conclusion Our results highlight three well-differentiated patient clusters with specific costs that could be used for stratification in both clinical and economic studies. Patient characteristics associated with adjudicated costs as well as cost trajectories may enable an early understanding of the magnitude of upcoming AF-related healthcare costs. What is already known on this topic Atrial fibrillation (AF) is a complex disease and constitutes a major economic and societal challenge due to its high prevalence worldwide. What this study adds This study, based on a large prospective cohort study, provides evidence on real-world AF costs and their development over time. Data-derived patient clusters are linked to costs and their respective cost trajectories are assessed. How this study might affect research, practice or policy The identified patient clusters and their characteristics may help clinicians and payers to gain an early insight and understanding of the magnitude of the expected AF-related healthcare costs. ### Competing Interest Statement Dr. Auricchio is a consultant with Abbott, Boston Scientific, Backbeat, Cairdac, Corvia, EP Solutions, Medtronic, Microport CRM, Philips, XSpline; he participates in clinical trials sponsored by Boston Scientific, Medtronic, Microport CRM, Philips and XSpline; and has intellectual properties assigned to Boston Scientific, Biosense Webster, and Microport CRM. Dr. Beer reports grant support from the Swiss National Foundation of Science, The Swiss Heart Foundation and the Stiftung Kardio; grant support, speakers- and consultation fees to the institution from Bayer, Sanofi and Daichii Sankyo. Dr. Bonati reports personal fees and nonfinancial support from Amgen, grants from AstraZeneca, personal fees and nonfinancial support from Bayer, personal fees from Bristol-Myers Squibb, personal fees from Claret Medical, grants from Swiss National Science Foundation, grants from University of Basel, grants from Swiss Heart Foundation, outside the submitted work. Dr. Conen received consulting fees from Roche Diagnostics, and speaker fees from Servier and BMS/Pfizer, all outside of the current work. Dr. Kuehne reports personal fees from Bayer, personal fees from Boehringer Ingelheim, personal fees from Pfizer BMS, personal fees from Daiichi Sankyo, personal fees from Medtronic, personal fees from Biotronik, personal fees from Boston Scientific, personal fees from Johnson&Johnson, personal fees from Roche, grants from Bayer, grants from Pfizer, grants from Boston Scientific, grants from BMS, grants from Biotronik, grants from Daiichi Sankyo. Dr. Moschovitis has received consultant fees for taking part to advisory boards from Novartis, Boehringer Ingelheim, Bayer, Astra Zeneca and Daiichi Sankyo, all outside of the presented work. Dr. Mueller reports fellowship and training support from Biotronik, Boston Scientific, Medtronic, Abbott/St. Jude Medical, and Biosense Webster; speaker honoraria from Biosense Webster, Medtronic, Abbott/St. Jude Medical, AstraZeneca, Daiichi Sankyo, Biotronik, MicroPort, Novartis, and consultant honoraria for Biosense Webster, Medtronic, Abbott/St. Jude Medcal, and Biotronik. Dr. Osswald received research grants from the Swiss National Science Foundation and from the Swiss Heart Foundation, research grants from Foundation for CardioVascular Research Basel, research grants from Roche, educational and speaker office grants from Roche, Bayer, Novartis, Sanofi AstraZeneca, Daiichi-Sankyo and Pfizer. Dr. Reichlin has received research grants from the Swiss National Science Foundation, the Swiss Heart Foundation, and the sitem insel support fund, all for work outside the submitted study. Speaker/consulting honoraria or travel support from Abbott/SJM, Astra Zeneca, Brahms, Bayer, Biosense-Webster, Biotronik, Boston-Scientific, Daiichi Sankyo, Medtronic, Pfizer-BMS and Roche, all for work outside the submitted study. Support for his institution's fellowship program from Abbott/SJM, Biosense-Webster, Biotronik, Boston-Scientific and Medtronic for work outside the submitted study. Dr. Schwenkglenks reports grants from Swiss National Science Foundation, for the conduct of the study; grants and personal fees from Amgen, grants from MSD, grants from Novartis, grants from Pfizer, grants from The Medicines Company, all outside the submitted work. Dr. Serra-Burriel reports grants from the European Commission outside of the present work. Dr. Sticherling has received speaker honoraria from Biosense Webster and Medtronic and research grants from Biosense Webster, Daiichi-Sankyo, and Medtronic. The remaining authors have nothing to disclose. ### Funding Statement This work is supported by grants of the Swiss National Science Foundation (grant numbers 105318\_189195 / 1, 33CS30\_148474, 33CS30\_177520, 32473B\_176178, and 32003B_197524), the Swiss Heart Foundation, the Foundation for Cardiovascular Research Basel (FCVR), and the University of Basel. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Swiss-AF study protocol was approved by the local ethics committee (Ethikkommission Nordwest- und Zentralschweiz), and written informed consent was obtained from each participant. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The patient informed consent forms state that the data, containing personal and medical information, are exclusively available for research institutions in an anonymized form and are not allowed to be made publicly available. Researchers interested in obtaining the data for research purposes can contact the Swiss-AF scientific lead. Contact information is provided on the Swiss-AF website (). Authorization of the responsible ethics committee is mandatory before the requested data can be transferred to external research institutions.