Hospitalisation and healthcare use in persons screened for atrial fibrillation compared with usual care.

Abstract

The impact of screening for incident atrial fibrillation (AF) on healthcare use and hospitalisation is largely unknown. This post-hoc LOOP study analysed healthcare data from AF-naïve >70-year-olds randomised to AF screening with implantable loop recorder (ILR) or usual care. We extracted all general practitioner (GP) consultations, outpatient and emergency department (ED) visits, and hospitalisations from Danish nationwide health registries over a six-year period. We estimated incidence rate ratios (IRR), and hazard ratios (HRs) for all-cause contacts and stratified by contact-diagnosis of incident AF. The 6,004 participants, had 233,171 all-cause GP consultations, 96,879 all-cause outpatient/ED visits, and 18,851 all-cause hospitalisations with a median follow-up of 6.4 (6.0;6.8) years,. Compared to usual care, the screening group had higher incidences of all outcomes (GP consultation 6.58 (6.53;6.64) vs 6.27 (6.24;6.30) events per person-year (PPY), IRR 1.05 (1.04;1.05); outpatient visit 2.69 (2.66;2.72) vs 2.63 (2.61;2.65) PPY, IRR 1.02 (1.01;1.04); hospitalisation 0.54 (0.53;0.56) vs 0.52 (0.51;0.52) PPY, IRR 1.06 (1.02;1.09)) and higher relative risk of GP consultation (HR 1.11 (1.05;1.18)), all-cause outpatient/ED visit (HR 1.14 (1.07;1.21)), AF outpatient/ED visit (HR 5.30 (4.07;6.90)), and AF hospitalisation (HR 1.90 (1.44;2.49), whereas all-cause hospitalisation was similar across randomisation groups. For all events, males had a 13-14% lower rate of GP consultations and a 18-20% higher rate of hospitalisation than females. Long-term screening for incident AF was associated with significantly more GP consultations and outpatient/ED visits compared with usual care, whereas all-cause hospitalisations were unaffected. Women had more GP consultations and fewer hospitalisations than men.