Areas of Focus

Atrial Fibrillation with Rapid Ventricular Rate (AFib-RVR) 

Atrial fibrillation (AFib) is the most common arrhythmia, presenting with an irregular and often rapid heart rate that increases the risk of stroke and may increase the risk of heart failure and other heart-related complications.

During AFib, the heart’s two upper chambers, or atria, beat chaotically, irregularly, and out of coordination with the two lower chambers, or ventricles. Depending on many factors, the lower chambers, which are the ones that determine your heart rate, may beat at a rapid rate. When there is a rapid heart rate during AFib, it is referred to as “atrial fibrillation with rapid ventricular rate (RVR)”. Symptoms of AFib with RVR often include palpitations, shortness of breath, and weakness.

Frequency and Severity

Episodes of AFib may come and go (paroxysmal AFib), or patients may have AFib that never goes away (permanent or “fixed” AFib), but both almost always require treatment.

Although AFib itself is rarely life-threatening, it is a serious medical condition. It may require emergency medical treatment and if untreated is associated with a significant increase in the risk of stroke with large clots that can lead to the possible loss of a limb.

Prevalence

Recent prevalence estimates in the U.S. indicate that over 10 million patients suffer from AFib. Approximately 25% of these patients have paroxysmal AFib, which resolves spontaneously within seven days of symptom onset. Another 25% have persistent AFib, which fails to terminate within seven days of symptom onset and requires treatment to convert back to sinus rhythm; and 50% have permanent AFib, in which the AFib never comes back to normal despite treatment, or a joint decision is reached to leave the patient in AFib and keeping the heart rate under control and managing symptoms. Market research has shown that 30-40% of all patients with AFib experience at least one episode per year with RVR requiring treatment.

Healthcare Economics

Current AFib management consumes significant healthcare resources in the U.S. In a retrospective claims analysis from commercial and Medicare databases, patients with AFib were more likely to be hospitalized and die during admission compared to their non-AFib counterparts. Additionally, the total incremental cost of AFib in the inpatient setting, outpatient primary care setting, and outpatient pharmacy was over $8,705 per patient. US Healthcare Cost and Utilization Project (HCUP) data 2015-2019 shows an 8.9% increase in emergency department utilization for AFib from 2015 to 2019. The American Heart Association recently published a report summarizing the current and projected cost burden of cardiovascular diseases in the U.S. This report suggests AFib resulted in $24 billion in direct medical costs in 2015 (~8% of all cardiovascular diseases) and another $7 billion in indirect costs (i.e., $31 billion in total costs). Additionally, the forecasted growth in AFib prevalence is anticipated to result in total healthcare expenditures (direct and indirect) of $66 billion in the U.S. by 2035.

References

  1. Colilla, S., Am J Cardiol. 2013; 112(8):1142-7.
  2. Chiang, C., Circ Arrhythm Electrophysiol. 2012 5(4): 632-9.
  3. Noubiap, J., JACC 2024; 84(16):1501-1508.
  4. Joglar, J., Circ 2024; 149: e1-e156.
  5. Healthcare Resource Utilization Project (HCUP) 2019.
  6. Heart.org: Projections in Cardiovascular Disease Prevalence and Costs: 2015-2035.
  7. Triangle Insights Analysis, Quantitative Survey N=250 clinical cardiologists, interventional cardiologists, and electrophysiologists, conducted May 2021