背景:预防中风是房颤(AF)管理的核心,但抗凝治疗的房颤患者仍存在不良结局的残余风险.因此,目前的指导方针提出了一种更全面或综合的房颤管理方法,基于心房颤动更好的护理(ABC)途径,如下:A:抗凝治疗避免卒中;B:更好的症状控制,以患者为中心的症状指导决定心率或节律控制;C:心血管和合并症管理,包括生活方式因素。从英国NHS的角度来看,还没有正式的医疗成本分析,ABC途径的实施,以优化房颤的管理。我们的目标是估计英国每年到2040年的房颤患者数量,他们的发病率和死亡率。以及相关的医疗费用。其次,为了估计实施ABC途径的发病率和死亡率的改善,以及对成本的影响。
结果:2020年估计有1.463.538例房颤患者,每年可获得2.86亿英镑的中风护理和1.91亿英镑的与出血相关的护理。到2030年,预计将有2.115.332AF患者,导致6.66亿英镑的中风医疗保健和4.44亿英镑的与出血相关的医疗保健。到2040年,预计将上升到2.856.489例房颤患者,当年有109.6万英镑的中风医疗保健和7.31亿英镑的与出血相关的医疗保健。如果在2040年,患者通过ABC途径进行管理,这可以预防3.724和18.622之间的中风,在5.378和26.890之间出血并挽救了16.131和80.653之间的生命,这取决于通过该途径管理的患者比例。这相当于今年的成本减少了1.439亿英镑至7.196亿英镑。
结论:我们估计,与AF相关的英国NHS将带来巨大的医疗负担,从中风,在接下来的几十年里流血和死亡。如果患者采用基于ABC途径的整体或综合护理方法进行管理,这可以防止中风和出血,相当于大幅降低NHS医疗保健成本,拯救生命.
BACKGROUND: Stroke prevention is central to the management of atrial fibrillation (AF), but there remains a residual risk of adverse outcomes in anticoagulated AF patients. Hence, current guidelines have proposed a more holistic or integrated approach to AF management, based on the Atrial fibrillation Better Care (ABC) pathway, as follows: (A) avoid stroke with anticoagulation; (B) better symptom control with patient-centred symptom directed decisions on rate or rhythm control; and (C) cardiovascular and comorbidity management, including lifestyle factors. There has been no formal healthcare cost analysis from the UK National Health Service (NHS) perspective of ABC pathway implementation to optimize the management of AF. Our aim was to estimate the number of patients with AF in the UK each year up to 2040, their morbidity and mortality, and the associated healthcare costs, and secondly, to estimate improvements in morbidity and mortality of implementing an ABC pathway, and the impact on costs.
RESULTS: In 2020, there were an estimated 1 463 538 AF patients, resulting in £286 million of stroke care and £191 million of care related to bleeds annually. By 2030, it is expected that there will be 2 115 332 AF patients, resulting in £666 million of stroke healthcare and £444 million of healthcare related to bleeds. By 2040, this is expected to rise to 2 856 489 AF patients, with £1096 million of stroke healthcare and £731 million of healthcare related to bleeds for that year. If in 2040 patients are managed on an ABC pathway, this could prevent between 3724 and 18 622 strokes and between 5378 and 26 890 bleeds, and save between 16 131 and 80 653 lives depending on the proportion of patients managed on the pathway. This would equate to cost reductions of between £143.9 million and £719.6 million for the year.
CONCLUSIONS: We estimate that there will be a substantial healthcare burden in the UK NHS associated with AF, from strokes, bleeds, and mortality over the next decades. If patients are managed with a holistic or integrated care approach based on the ABC pathway, this could prevent strokes and bleeds that equate to substantial NHS healthcare cost reductions, and save lives.