Biomedical subjects

Karin S Coyne

Publications and source records attributed to Karin S Coyne.

17 recordsLinked to original sources

PubMed2007

The responsiveness of the OAB-q among OAB patient subgroups.

AIMS: Although the majority of patients with overactive bladder (OAB) are continent, most patient-reported outcome measures for OAB were designed for patients with urinary incontinence. The overactive bladder questionnaire (OAB-q) was developed to assess symptom bother and HRQL among both continent and incontinent OAB patients; however, the responsiveness of the OAB-q among continent patients has not been evaluated. The purpose of this analysis was to assess the responsiveness of the OAB-q among OAB patient subgroups with a focus on continent patients. METHODS: Post-hoc analyses were conducted from two 12-week trials of tolterodine for the treatment of OAB. Patients completed the OAB-q and daily bladder diaries (assessing frequency, urgency, and incontinence episodes) at baseline, 4 weeks, and 12 weeks. Three patient subgroups were identified on the basis of continence status at all three timepoints: (1) continent; (2) incontinent; and (3) incontinent at baseline and continent by Week 12 (ITC). General linear models were used to compare changes from baseline, and Spearman correlations assessed the association between OAB-q changes and bladder diary changes. Effect sizes were computed separately for each group. RESULTS: A total of 262 continent, 552 incontinent, and 397 ITC patients were included in this analysis. Continent patients tended to be younger than incontinent patients, and patients were predominantly female, although continent patients had the highest percentage of male patients in both studies. Compared with continent patients, patients who were incontinent at baseline tended to have greater symptom bother and lower HRQL at baseline. All OAB-q change scores were consistently greatest for the ITC group (12.1-33.9), and greater for continent patients (10.8-28.6) than for incontinent patients (7.6-20.1). All three groups of patients experienced reductions in frequency and urgency episodes, and these changes were significantly correlated with changes in the OAB-q scales. Among all three groups, effect sizes were in the moderate-to-large range for all OAB-q subscales except Social Interaction. CONCLUSIONS: The OAB-q is highly responsive to change between continent and incontinent patients with OAB, and is a valid tool for measuring treatment outcomes among continent OAB patients.

Adaptation, Psychological↗

PubMed2006

Evaluating the impact of overactive bladder on sexual health in women: what is relevant?

INTRODUCTION: To assess sexual health, relevant, valid, and reliable questionnaires need to be used. AIM: To assess the relevance and content validity of three sexual health questionnaires in women with overactive bladder (OAB) and urinary incontinence. MAIN OUTCOME MEASURES: Sexual Quality of Life Questionnaire--Female (SQoL-F), Sexual Function Questionnaire (SFQ), and Pelvic Organ Prolapse-Incontinence Sexual Function Questionnaire (PISQ). METHODS: Women with OAB and urinary incontinence were recruited from five urology clinics in the United States; those who were interested in participating were mailed questionnaire packets with instructions. Each questionnaire item was followed by three questions regarding the understandability, relevance, and impact of bladder condition when responding to the question. Patients returned the completed questionnaires by mail; clinical information was obtained from chart review. RESULTS: A total of 129 patients (74% response) returned the questionnaires. The mean age was 56 years; 78% were white; 64% were married. In this sample, 64% had urge incontinence; 32% had mixed incontinence; and 4% had stress incontinence. Participants experienced bladder symptoms for a mean of 12.2 years with the following treatments: surgery (43%), bladder training (26%), exercise/biofeedback (42%), and medications (67%). SQoL-F items were understood by more than 97% of the respondents, more than 89% for SFQ, and more than 82% for PISQ. There were two SQoL-F items, one SFQ item, and 11 PISQ items that less than 60% of the respondents deemed relevant to their bladder condition. Correlations among questionnaire items and relevance to bladder condition ranged from 0.04 to 0.64 for the SQoL-F, 0.04 to 0.47 for the SFQ, and 0.01 to 0.58 for the PISQ. CONCLUSION: Women with OAB found the majority of items on all three questionnaires to be relevant to their bladder condition. Of these questionnaires, the SQoL-F had the highest understandability, fewest questions considered irrelevant, and correlated well with OAB symptoms.

Adult↗

PubMed2006

The validation of the patient perception of bladder condition (PPBC): a single-item global measure for patients with overactive bladder.

OBJECTIVES: The purpose of this study was to evaluate the validity and responsiveness of a global measure for overactive bladder (OAB), the Patient Perception of Bladder Condition (PPBC). METHODS: Post-hoc analyses were conducted on two 12-wk clinical trials for OAB (Study 1: n = 865; Study 2: n = 520). In addition to the PPBC, patients completed two condition-specific health-related quality of life (HRQL) measures, the Overactive Bladder Questionnaire (OAB-q) and King's Health Questionnaire (KHQ), and bladder diaries at baseline and 12 wk. Validity of the PPBC was evaluated through correlations with baseline diaries, OAB-q, and KHQ. The responsiveness of the PPBC was evaluated using correlations and general linear models to assess the degree of association between change in PPBC and change in the diaries, OAB-q, and KHQ. RESULTS: Both samples were primarily women and white with mean ages of 61.0 and 58.8 yr. The majority of patients were incontinent (75.3% and 80.4%) with the greatest proportion of patients indicating that they had "moderate problems" (47.5% and 51.2%) on the PPBC at baseline. Significant correlations were present at baseline and among change scores between the PPBC and the bladder diaries (p < 0.001), OAB-q (p < 0.001), and KHQ (p < 0.01). In both studies, patients with major PPBC improvement had significantly greater reductions in frequency, urgency episodes, incontinence episodes, and Symptom Bother and significantly greater improvements in HRQL than patients with only a minor PPBC improvement. CONCLUSION: The PPBC, a global patient-reported measure of bladder condition, demonstrated good construct validity and responsiveness to change. These findings support the use of the PPBC as a global assessment of bladder condition among patients with OAB.

Female↗

PubMed2006

Determining the importance of change in the overactive bladder questionnaire.

PURPOSE: The overactive bladder questionnaire assesses symptom bother and health related quality of life in patients with overactive bladder. It has been shown to be reliable, valid and responsive. We established the minimally important difference of the overactive bladder questionnaire. MATERIALS AND METHODS: Post hoc analyses from 2 clinical trials were performed. Distribution based, eg effect size, and anchor based analyses using perception of treatment benefit and clinical variables were used. RESULTS: The mean age of the 2 study populations was 58.8 and 58.7 years, respectively. Patients were predominantly female (51.8% and 75.1%) and white (83.9% and 87%, respectively). Half SD of the overactive bladder questionnaire symptom bother subscale was 9.1 to 9.3, and half SD of the overactive bladder questionnaire health related quality of life subscales (coping, concern, sleep and social interaction) was 9.8 to 13.2. Questionnaire subscales had moderate to large effect sizes with the largest effect sizes for symptom bother (-0.85 to -1.09). Anchor based analyses showed that significantly greater change scores were associated with greater patient perceived treatment benefit and satisfaction. The difference between change scores in patients perceiving no and little benefit was 7.4 to 16.5 for all questionnaire scales except social interaction with the majority greater than 10 points. Greater change scores were consistently associated with greater improvements in micturition diary variables. CONCLUSIONS: Multiple methodologies provide strong justification for the recommendation of a 10-point minimally important difference for all overactive bladder questionnaire subscales. This minimally important difference may be conservative for some subscales, although a uniform minimally important difference is recommended to facilitate interpretation of the overactive bladder questionnaire.

Female↗

PubMed2006

Translating overactive bladder questionnaires in 14 languages.

OBJECTIVES: Overactive bladder (OAB) affects millions of people worldwide. Identifying patients and measuring OAB's impact on symptom severity and patients' health-related quality-of-life is necessary to ensure proper treatment and facilitate communication among patients, clinicians, and caregivers. To accomplish this, the Overactive Bladder questionnaire (OAB-q) and its subsets instruments, the OAB-q Short-Form and the OAB-V8, were developed in U.S. English. To measure the impact of OAB cross-culturally, we performed the linguistic validation of these instruments in Danish, English (Canada), French (Canada and France), Italian (Switzerland), German (Switzerland), Korean, Norwegian, Polish, Portuguese (Brazil), Romanian, Swedish, and Turkish. The linguistic validation was conducted following a rigorous method to ensure conceptual equivalence between the original and its translations. METHODS: In each country, a specialist monitored the process, which included six steps: (1) two forward translations; (2) comparison and reconciliation of the translations; (3) back-translation; (4) comparison of the source and back-translation; (5) review by one urologist or gynecologist; and (6) a comprehension test using patients. RESULTS: The translation of symptom-related adjectives such as "uncomfortable," "sudden," "accidental," "uncontrollable" proved challenging. The subtle differences in the meaning of symptomatic items increased the difficulties to find equivalents. Issues regarding the appropriateness of certain concepts and idiomatic terms emerged during cognitive debriefing. The terms "urge," "desire," "urination," "commute," "drowsy," and "escape routes" were not retained literally and were replaced by colloquial expressions. CONCLUSIONS: The 14 versions of the OAB-q, OAB-q Short-Form, and OAB-V8 were successfully validated linguistically to facilitate data collection cross-culturally and the international comparison of symptom bother and health-related quality of life in patients with OAB.

Language↗

PubMed2006

Development and validation of patient-reported outcomes measures for overactive bladder: a review of concepts.

Patient-reported outcome (PRO) measures are a valuable means for determining how a disease and its treatment affect patients, including effects on health-related quality of life (HRQL). To ensure that the results obtained with PROs are clinically useful, data must be gathered using valid and reliable instruments. Developing such instruments requires a multistep, structured process that incorporates cognitive psychology, psychometric theory, and patient and clinician input. The process begins by determining the intent and purpose of the PRO and culminates in studies that demonstrate the measure's validity, reliability, and responsiveness. Several valid and reliable PROs are available for assessing the effects of treatment on symptom severity, symptom bother, and HRQL in patients with overactive bladder.

Cultural Characteristics↗

PubMed2006

Patient-reported outcomes in overactive bladder: importance for determining clinical effectiveness of treatment.

Overactive bladder (OAB) is a condition defined by its symptoms--urinary urgency with or without urgency urinary incontinence and often with frequency and nocturia. As such, determining the efficacy of OAB treatments using objective measures, such as urodynamic testing, can be difficult. A better means of gauging treatment efficacy for symptom-based conditions is through the use of patient-reported outcomes (PROs). With PROs, clinicians can gain insight into how a treatment affects a patient's symptoms and whether improvement in symptoms has a positive effect from the patient's perspective. PROs are increasingly being included as end points in clinical trials, including those of antimuscarinic drugs for OAB. Consequently, clinicians should become familiar with the most commonly used instruments. We provide an overview of instruments used to assess symptoms, health-related quality of life, and treatment satisfaction in patients with OAB and discuss how PROs can be incorporated into clinical trial protocols.

Benzhydryl Compounds↗

PubMed2005

Test-retest reliability of four questionnaires for patients with overactive bladder: the overactive bladder questionnaire (OAB-q), patient perception of bladder condition (PPBC), urgency questionnaire (UQ), and the primary OAB symptom questionnaire (POSQ).

AIMS: This study examined test-retest reliability of four patient-reported outcome measures for patients with overactive bladder (OAB): Overactive Bladder Questionnaire (OAB-q), Patient Perception of Bladder Condition (PPBC), Urgency Questionnaire (UQ), and Primary OAB Symptom Questionnaire (POSQ). METHODS: Patients recruited from urology clinics were scheduled for two visits 2 weeks apart and completed all questionnaires at both visits. A demographic form was completed at Visit 1; and a treatment effect scale was completed at Visit 2. Test-retest reliability was examined among stable patients using intraclass correlations (ICC), Spearman's correlations, paired t-tests, Feldt's statistic, and kappas. RESULTS: A total of 47 patients enrolled (mean age = 66.0 years, 74.5% female), with 46 completing both visits; 35 were classified stable. Statistically significant correlations were present between Visits 1 and 2 (P < 0.05) for all subscales of the OAB-q, UQ, and POSQ. Subscale ICCs were moderate to high (OAB-q > or = 0.83, UQ > or = 0.46, POSQ continuous items > or = 0.68). No significant differences between Visit 1 and 2 were noted, except for the OAB-q symptom bother scale (change of 5.8 points on a 100-point scale). The multi-item subscales of the OAB-q and the UQ demonstrated good internal consistency (Cronbach's alpha > or = 0.83 for all subscales) across both visits. Test-retest reliability of the PPBC was somewhat weaker than the other three measures, but still acceptable for use as a global, single-item outcome measure. CONCLUSIONS: The OAB-q, POSQ, and UQ demonstrated good test-retest reliability, with ICCs roughly equivalent or superior to those previously reported for 7-day micturition diaries. Findings suggest that the four measures examined in this study demonstrate the necessary reproducibility for use as outcome measures for OAB treatments.

Aged↗

PubMed2005

The responsiveness of the Overactive Bladder Questionnaire (OAB-q).

PURPOSE: The purpose of this study was to examine the responsiveness of the Overactive Bladder questionnaire (OAB-q) during anti-muscarinic treatment. METHODS: OAB patients were treated with tolterodine ER 4 mg/day for 12 weeks. The OAB-q and 3-day micturition diaries were collected at baseline, 4, and 12 weeks. The patients' and physicians' perceptions of treatment benefit were assessed at 4 and 12 weeks. Responsiveness of the OAB-q was examined with effect sizes and comparisons to other measures using ANOVAs, t-tests, and correlations. RESULTS: A total of 865 patients completed the 12-week study (mean age 61 years; 73% female; 89% Caucasian). From baseline to 4 weeks, significant improvements (p < 0.0001) occurred in all OAB-q subscales, which were maintained through week 12. The OAB-q was highly responsive with subscale effect sizes ranging from 0.44 (social interaction) to 1.2 (symptom bother). Significant score changes in all OAB-q subscales (p < 0.05) were associated with reductions of > or = 3 urgency episodes, > or = 3 micturitions, or > or = 1 incontinence episode per day. Improvements in OAB-q scales were associated with changes in patient and physician perceptions of treatment benefit. CONCLUSIONS: The OAB-q was highly responsive and demonstrated responsiveness to reductions in urinary urgency, frequency, and incontinence during antimuscarinic treatment of OAB. The OAB-q appears to be a useful outcome measure for treatments of OAB.

Benzhydryl Compounds↗

PubMed2005

Validation of the urgency perception scale.

OBJECTIVE: To ascertain the validity and responsiveness of the Urgency Perception Scale (UPS) as an indicator of perceived urinary urgency. PATIENTS AND METHODS: The UPS was developed to assess perceived urinary urgency in clinical studies evaluating the efficacy of the antimuscarinic drug, tolterodine, for treating the overactive bladder (OAB) syndrome. Secondary analyses of clinical and patient assessment data from three clinical studies of tolterodine were conducted to evaluate the UPS. Construct validity was assessed by correlations between the UPS and patient voiding diary variables and other patient assessments, including: perception of bladder condition; perception of treatment benefit; the Medical Outcomes Study Short-Form 36 health survey; the King's Health Questionnaire; the OAB Questionnaire; and the Overall Treatment Effect scale. RESULTS: The UPS correlated well with the patients' perception of bladder condition (correlation coefficients - 0.29 to - 0.46; all P < 0.001) and with the voiding diary variables, especially incontinence episodes (-0.30 to - 0.41) and pad usage (-0.25 to - 0.38; all P < 0.001). An improvement in UPS score at the end of treatment was consistently reflected by significant improvements among all voiding variables. CONCLUSION: Urinary urgency is a central symptom of OAB and is particularly bothersome because of its unpredictability and consequent impact on daily life. The UPS is a valid scale by which urinary urgency can be assessed subjectively, and provides a useful tool for research into urinary urgency.

Aged↗

PubMed2005

Application of structural equation modeling to health outcomes research.

This article provides an overview of the basic underlying principles of structural equation modeling (SEM). SEM models have two basic elements: a measurement model and a structural model. The measurement model describes the associations between the indicators (observed measures) of the latent variables, whereas the structural model delineates the direct and indirect substantive effects among latent variables and between measured and latent variables. The application of SEM to health outcomes research is illustrated using two examples: (a) assessing the equivalence of the SF-36 and patient evaluations of care for English- and Spanish-language respondents and (b) evaluating a theoretical model of health in myocardial infarction patients. The results of SEM studies can contribute to better understanding of the validity of health outcome measures and of relationships between physiologic, clinical, and health outcome variables.

Cross-Cultural Comparison↗

PubMed2004

The impact of diabetic retinopathy: perspectives from patient focus groups.

BACKGROUND: Diabetic retinopathy (DR) affects 50-85% of people with diabetes and may result in visual impairment or blindness. OBJECTIVE: This exploratory qualitative research was conducted to evaluate the symptom experience of DR, its impact on daily activities and health-related quality of life (HRQL), and the applicability of two vision-specific questionnaires. METHODS: Four focus groups (n = 15) were conducted with people with DR to explore their symptom experience and the impact on functioning and HRQL. Adults with type I or II diabetes and mild, moderate or severe non-proliferative DR (NPDR) or proliferative DR (PDR) were recruited. Content analysis and descriptive statistics were used to analyse the data. RESULTS: Participants described a range of symptoms and impact. Difficulty driving, especially at night, and trouble reading were noted with all levels of severity. Participants with PDR and decreased visual acuity have foregone many other important life aspects such as work, reading and sports. For the severely affected, diabetic care activities (e.g. exercising, reading nutritional labels, preparing insulin injections and glucose testing) were difficult to accomplish. Loss of independence, especially mobility and increased fear of accidents, had a profound impact on social activities. For those patients who had not experienced other complications of diabetes, the threat of vision loss was the most devastating. CONCLUSION: The loss of independence and mobility associated with decreased visual functioning and visual loss were major concerns. Moderate, severe NPDR and PDR associated with visual impairment have a significant impact on HRQL, particularly in the areas of independence, mobility, leisure and self-care activities.

Activities of Daily Living↗

PubMed2003

Evaluating effects of method of administration on Walking Impairment Questionnaire.

BACKGROUND: Intermittent claudication resulting from peripheral arterial disease (PAD) can substantially impair walking function. The Walking Impairment Questionnaire (WIQ) assesses patient self-reported difficulty in walking. Currently this questionnaire is validated for interviewer administration only. Since this can be burdensome in a large clinical trial, we examined the effects of alternative methods of administration on patient responses on the WIQ. METHODS: The WIQ, which consists of four subscales (pain severity, distance, speed, stairs), was modified to be self-administered or interviewer-administered by telephone. Patients with PAD were recruited from two sites and randomized into two groups: in group 1 the WIQ was self-administered, then telephone-administered; in group 2 the WIQ was telephone-administered, then self-administered. The two administrations occurred 4 to 7 days apart. Additional measures (SF-36, EQ-5D, and PAD symptom scale) and clinical data were included to further assess the validity of the WIQ and symptoms in patients with claudication. Telephone interviews were conducted by trained interviewers using standardized scripts. Two-week test-retest reliability was assessed for both the self-administered WIQ (group 1) and the telephone-administered WIQ (group 2). RESULTS: Sixty patients were recruited at two sites (n = 30 per group). Seventy-eight percent were men; mean patient age was 67.1 years; and 83% of patients were white. Mean duration of PAD symptoms was 6.8 years. No significant differences were observed in WIQ subscale scores between self administration and telephone administration. No interaction effects between order and method of administration were detected. Cronbach alpha for distance, speed, and stair-climbing subscales ranged from 0.82 to 0.94. Correlations among WIQ subscales and the symptom scale were good (r = -0.34 to -0.57). Correlations of WIQ subscales with physical health subscales of the SF-36 (r = 0.24-0.59) were higher than for mental health-related subscales (r = 0.08-0.26). CONCLUSIONS: The modified WIQ demonstrated good reliability and validity with both methods of administration. These results suggest that the self-administered and telephone-administered versions of the WIQ can be used reliably and efficiently in clinical trials.

Aged↗

PubMed2002

Health-related quality of life in patients treated for hypertension: a review of the literature from 1990 to 2000.

BACKGROUND: The goals of antihypertensive therapy are to achieve and maintain blood pressure control by the least intrusive means possible to prevent future cardiovascular and renal events. To achieve these goals, pharmacologic agents must be chosen so as to minimize drug-related adverse events, increase patient adherence to treatment regimens, and minimize the negative impact on health-related quality of life (HRQL). Although the effects of antihypertensive therapy on HRQL have been extensively investigated, there is little synthesis of the research findings. OBJECTIVE: This review was undertaken to provide a synthesis of the available data on the impact of antihypertensive therapy on HRQL and to provide recommendations for future research. METHODS: A MEDLINE literature search was conducted to identify English-language articles published from 1990 to 2000 that included random assignment to antihypertensive treatment and HRQL as an outcome. In addition, reference lists of published reviews and other trials were reviewed to identify other studies of HRQL and antihypertensive therapy. RESULTS: A total of 48 articles were included in the review. Results among studies were frequently inconsistent, which is likely due to the wide variety of dimensions studied and instruments used as well as a number of methodological weaknesses, including small sample sizes, short-term assessments, and failure to account for missing data. CONCLUSION: A standardized approach to the assessment of HRQL in hypertensive patients is needed so that research in this area can be of value to clinical practice and to hypertensive patients and their families.

Antihypertensive Agents↗

PubMedDate not supplied

Validation of an overactive bladder awareness tool for use in primary care settings.

Overactive bladder (OAB)--a syndrome characterized by urinary urgency, with or without urge incontinence, urinary frequency and nocturia--is estimated to affect 10% to 20% of the US and European populations. This study was carried out to validate a patient-administered screening awareness tool to identify patients with bothersome OAB symptoms. Patients were recruited from 12 primary care and 1 gynecology practice during regularly scheduled appointments. Enrollees completed an 8-item questionnaire assessing the amount of "bother" they associated with OAB symptoms. Clinicians then asked the patients 4 questions regarding urinary frequency, urgency, nocturia, and incontinence. If the screening was positive for symptoms of OAB or if the patient provided positive responses to the urinary symptom questions, the clinician asked additional questions regarding lifestyle and coping behaviors. The clinician then diagnosed the patient, placing him or her in the "No OAB," "Possible OAB," or "Probable OAB" category. Multivariable logistic regressions controlling for age and sex were performed to assess the applicability of the tool for identifying patients with OAB. A total of 1,299 patients were enrolled, and 1,260 provided complete data. Patients were aged 51.6+/-17.0 years, 62% were female, most (89%) were Caucasian, 22% experienced urinary urgency, and 18% experienced urge incontinence. The prevalence of Probable OAB was 12%. The c-index of the model identifying patients with a diagnosis of Probable OAB was 0.96, with a sensitivity and specificity of 98.0 and 82.7. For OAB-V8 scores >or=8, the odds ratio for Probable OAB was 95.7 (95% CI: 29.3; 312.4). The OAB-V8 performed well in helping clinicians identify patients with bothersome OAB symptoms in a primary care setting and will assist clinicians in identifying patients who may benefit from treatment.

Female↗

PubMedDate not supplied

The impact of urinary urgency and frequency on health-related quality of life in overactive bladder: results from a national community survey.

OBJECTIVES: Overactive bladder (OAB) is described as urinary urgency, with and without urge incontinence and usually with frequency and nocturia. Most attention to OAB's impact on health-related quality of life (HRQL), however, has focused on urge incontinence. The objective of this study was to evaluate the burden of OAB, specifically urinary urgency and frequency on HRQL. METHODS: In the National Overactive Bladder Evaluation Program (NOBLE), a computer-assisted telephone interview survey was conducted to assess the prevalence of OAB in the United States. Based on interview responses, respondents were classified into three groups: continent OAB, incontinent OAB, and controls. To evaluate the HRQL impact of OAB, HRQL questionnaires were mailed to all respondents with OAB and age- and sex-matched controls as a performed nested case-control study. Continuous data were compared using Student's t tests and analysis of variance with post hoc pairwise comparisons; results were adjusted for age, sex, and comorbid conditions. Multivariable regressions were performed to assess the impact of each urinary variable on symptom bother and HRQL. RESULTS: A total of 919 participants responded to the questionnaires (52% response rate) with a mean age of 54.2 years (SD 16.4 years); 70.4% were female and 85% were white. Continent OAB participants comprised 24.8% of the sample, incontinent OAB 18.3%, and controls 56.9%. In each regression analysis, urinary urge intensity accounted for the greatest variance for increases in symptom bother and decreases in HRQL. CONCLUSIONS: The experience of urinary urgency has a significant negative effect on HRQL and increases symptom bother, an effect that, in this community sample, is greater than that of incontinence, frequency, or nocturia.

Aged↗

PubMedDate not supplied

Assessing the direct costs of treating nonvalvular atrial fibrillation in the United States.

OBJECTIVE: To determine the health-care resource use and costs attributable to treating atrial fibrillation (AF) in the United States. METHODS: Retrospective analyses of three federally funded US databases (2001 data): 1) hospital inpatient stays (the Healthcare Cost and Utilization Project [HCUP]); 2) physician office visits (the National Ambulatory Medical Care Survey [NAMCS]); and 3) emergency department (ED) and hospital outpatient department visits (OPD) (the National Hospital Ambulatory Medical Care Survey [NHAMCS]). Identification of AF medical encounters was based on occurrence of AF-specific International Classification of Diseases (9th Edition)--Clinical Modification (ICD-9-CM) diagnosis code 427.31 (principal discharge diagnosis for inpatient setting; any diagnosis field for other settings). For the 10 most common principal discharge diagnoses in the inpatient setting, case-control comparison analyses were performed to estimate annual incremental costs of AF as a comorbid discharge diagnosis for hospital stays. Regression models were used to assess the impact of AF on hospitalization costs. Costs were estimated in year 2005 US dollars. RESULTS: Approximately 350,000 hospitalizations, 5.0 million office visits, 276,000 ED visits, and 234,000 OPD were attributable to AF annually within the United States. Total annual costs for treatment of AF were estimated at $6.65 billion, including $2.93 billion (44%) for hospitalizations with a principal discharge diagnosis of AF, $1.95 billion (29%) for the incremental inpatient cost of AF as a comorbid diagnosis, $1.53 billion (23%) for outpatient treatment of AF, and $235 million (4%) for prescription drugs. In all regressions, AF was a significant contributor to hospital cost. CONCLUSIONS: Treatment of AF represents a significant health-care burden with the costs of treating AF in the inpatient setting outweighing the costs of treating AF in the office, emergency room or hospital outpatient settings. Further research is needed to fully capture the costs of treating AF.

Aged↗