OBJECTIVES: We aimed to assess the healthcare resource utilization (HCRU) and costs associated with atrial fibrillation (AF) and examined disparities in rural healthcare settings.

METHODS: This was a retrospective cohort study. Data were collected from IBM MarketScan Research Databases 2015-2019. We identified AF patients with at least one inpatient diagnosis or two outpatient diagnoses with AF and non-AF patients without any AF diagnoses. Age, gender, health plan types, US regions, and Charlson Comorbid Index were measured confounders. HCRU and costs were calculated over a 12-month follow-up period. Rural status was identified by Metropolitan Statistical Area. Two-part models were used to assess the association between outcomes and AF status, and between outcomes and rural setting. Bootstrapping was used to estimate the marginal effect and its 95% confidence interval (CI).

RESULTS: The final sample had 156,719 AF patients and 3,398,497 non-AF patients. AF patients had 10.18 (95%CI: 10.10, 10.27) more outpatient visits, 0.89 (95%CI: 0.88, 0.90) more emergency room visits, 1.59 (95%CI: 1.56, 1.62) longer inpatient length of stay, and 3.99 (95%CI: 3.95, 4.02) more medications than non-AF patients. AF patients were associated with $14,208 (95%CI: 13,887, 14,290) higher costs for payers, and $1,044 (95%CI: 1,034, 1,053) higher costs for patients. Rural patients with AF had 1.66 (95%CI: -1.94, -1.40) fewer outpatient visits and 0.21 (95%CI: -0.32, -0.10) fewer inpatient services, but 0.07 (95%CI: 0.04, 0.09) more emergency room visits and 1.17 (95%CI: 1.04, 1.30) medications prescribed compared to urban AF patients. Rural patient expenditures were similar for payers (-397, 95%CI: -926, 100) and patient costs (-2.2, 95%CI: -24, 20).