Background: We evaluated the economic burden of atrial fibrillation (AF) in nine European countries (Belgium, France, Germany, Italy, Netherlands, Poland, Spain, Sweden and UK).

Methods: Data were gathered from GARFIELD–AF, a prospective, global registry of adults with newly (<6 weeks) diagnosed AF and ≥1 stroke risk factor(s). Total annual direct costs due to AF were the sum costs of: medical visits, drug therapy, hospital admissions, diagnostic procedures, and other medical events due to AF. Direct unit costs were quantified based on days on drug therapy and events recorded in GARFIELD-AF. Varying lengths of follow-up were considered using Bang and Tsiatis method to handle censored cost data. Mean cost per patient/year was expressed as absolute cost (€) and as a percentage of the country-specific healthcare expenditure per capita.

Results: Data were collated from 20,074 patients; median follow-up 1.97 years and 42,435 person-years of observations. Highest expenditure was observed in Belgium and UK (€ 3473 and € 2712, respectively); Table 1. Poland, with the smallest total cost per patient/year, had the highest healthcare expenditure per capita (105%). Inpatient care was the main cost in all countries, ranging between 48% of the total costs (France and Sweden) and 71% (Belgium and Germany); Fig.1. Outpatient costs varied between 7% of the total cost (Poland) and 32% (Netherlands). Different treatment combinations are likely to be responsible for variations in drug treatment costs.

Conclusions: AF is gaining increasing importance as a public health problem. The economic burden correlates with differences in management between countries. Inpatient care represents the largest part of the total care costs in all countries. Further stratification of patients (e.g. using risk scores) may improve our understanding of the healthcare expenditure associated with AF.