Objectives: To provide a contemporary nationally representative assessment of atrial fibrillation (AF) and atrial flutter (AFL) expenditures in the U.S. Background: AF prevalence is rising. However, there has been no contemporary national assessment of AF expenditures. Methods: Using Medical Expenditure Panel Survey 2016-2021 data, we identified individuals with AF or AFL using International Classification of Disease-10 codes and reported total and categorized expenditures. Using two-part and gamma regression models, respectively, we estimated incremental expenditures with AF for the entire population and for individuals with common coexisting comorbidities. Among AF individuals, we identified characteristics associated with higher expenditures. Results: Of a weighted surveyed population of 248,067,064 adults, 3,564,763 (1.4%) had AF. Mean age was 71.9 +/ 10.6 years; 45.7% were female. Mean unadjusted annual total healthcare expenditure for AF individuals was $25,451 +/ $1,100 compared with $9,254 +/ $82 for non-AF individuals. The highest spending categories were inpatient visits ($7,975 +/ $733) and prescriptions ($6,505 +/ $372). AF expenditures increased over the study period by 11.1%. After adjustment, incremental annual expenditure attributable to AF was $6,188 per person. Incremental expenditures with AF were highest for those with cancer ($11,967, 95% CI $4,410 - $19,525), while AF did not significantly increase expenditures in HF (-$2,756, 95% CI -$10,048 - $4,535). Modified Charlson Comorbidity Index of 1 or >=2, uninsured status, cancer, poor income level, ASCVD, COPD, and later survey year were associated with higher expenditures. Conclusion: AF is associated with increasing healthcare expenditures. With changes in screening and management, expenditures need periodic reassessments.

The authors have declared no competing interest.

Dr. See received support from the Yale School of Medicine 2023 Fellowship for Medical Student Research. Dr. Murugiah received support from the National Heart, Lung, and Blood Institute of the National Institutes of Health (under award K08HL157727). Dr. Nanna reports research support from the American College of Cardiology (George F and Ann Harris Bellows Foundation), the Patient-Centered Outcomes Research Institute, the Yale Claude D. Pepper Older Americans Independence Center (P30AG021342), and the National Institute on Aging/National Institutes of Health (GEMSSTAR award: R03AG074067).

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