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Comorbidity in elderly patients with atrial fibrillation affects the “cost of illness”

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Objective: to analyze whether comorbidity affects the cost of treatment and medical services in elderly patients with atrial fibrillation (AF).

Materials and methods. We conducted a retrospective analysis of 98 patients with AF. Comorbidity was evaluated using the CIRS-G scale (Cumulative Illness Rating Scale for Geriatrics) and the Charlson criterion. The “cost of illness” calculations included direct costs only.

Results. In elderly patients with AF (mean age 74.7±8.8 years), high rate of comorbidity was typically found. Charlson comorbidity index amounted to 4.0±1.8, and the CIRS-G score – to 8.0±2.8. AF is often associated with heart diseases such as hypertension – 98.9%, coronary heart disease – 27.6%, and congestive heart failure – 76.5%. A patient with AF received on average 7.5±3.8 medications. Direct costs amounted to 18298.2±9440.4 RUB per patient with AF per year. Of this amount, 78.8% were spent for outpatient treatment, 16.5% for hospitalization and 4.7% for ambulance service. Cardiac medications comprised 66.4% of the total direct costs. In patients with high comorbidity, there are high costs of treatment of concomitant diseases, high secondary costs as well as costs for a doctor visit.

Conclusion. An average elderly patient with AF receives 7.5±3.8 permanent medications, which correlates with the severity of comorbidity by the Charlson index (r=0.59; p=0.000) and the CIRS-G score (r=0.29; p=0.004). Management of such patients at the outpatient clinic is by large (66.4%) associated with direct costs of the prescribed medications. However, patients with high comorbidity still need more vital drugs, as the cost of treatment of concomitant diseases increases. Notably, these patients spend 4 times more funds for drugs without proven efficacy.


About the Authors

S. V. Malchikova 
Kirov State Medical University
Russian Federation
Professor of the Department of hospital therapy

N. S. Maksimchuk-Kolobova
Kirov State Medical University
Russian Federation
assistant of the Department of polyclinic therapy

M. V. Kazakovtseva 
Kirov State Medical University
Russian Federation
associate Professor of the Department of hospital therapy


1. Zhuravlev Y.I., Thorikova V.N. Modern problems of measurement of multimorbidity. Pharmacy (in Russ.). 2013; 11 (154): 214-219.

2. Fortin M., Bravo G., Hudon C. Prevalence of multimorbidity among adults seen in family practice. Annals of Family Medicine. 2005; 3: 223-228.

3. Valderas J.M., Starfield B., Sibbald B. Defining comorbidity: implications for understanding health and health services. Annals of Family Medicine. 2009; 7 (4): 357-363.

4. Oganov R. G. Comorbid pathology in clinical practice. Cardiovascular therapy and prevention (in Russ.). 2017; 16 (6): 5-56.

5. Vertkin A. L., Kovacova I. O., Petrik E. A. et al. New opportunities for the use of markers of metabolism in clinical practice. Effective pharmacotherapy. Cardiology and angiology (in Russ.). 2011; 1: 78 – 86.

6. Belyalov F. I. treatment of diseases in the conditions of comorbidity: monograph. Under edited by F. I. Belyalov. Moscow. 2016; 544 s. (in Russ.).

7. Zhang M., Holman C. D., Price S. D. et al. Comorbidity and repeat admission to hospital for adverse drug reactions in older adults: retrospective cohort study. Br. Med. J. 2009; 338: a2752.

8. Vertkin A.L., Kovacova I.O. Belyalov F.I. Comorbid patient: a guide for practitioners (in Russian). Moscow. 2015; 160 s. (in Russ.).

9. Yakusevich V. V., Pozdnyakova E. M., Yakusevich V. VL. et al. An outpatient with atrial fibrillation: basic characteristics. The first data register Raquaza FP – Yaroslavl. Rational pharmacotherapy in cardiology (in Russ.). 2015; 11 (2): 149-152.

10. Miller M.D., Paradis C.F., Houck P.R. et al. Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Res. 1992; 41: 237e48.

11. Charlson M.E., Pompei P., Ales K.L. et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987; 40: 373-383.

12. The price list for paid services provided by the municipal healthcare institution “Kirov city hospital № 8” was approved by the resolution of the administration of the city of Kirov 24.03.2011 № 836-P (in Russ.).

13. The territorial program of state guarantees of rendering to citizens of the Russian Federation of free medical care in the territory of the Kirov region for 2012 by the order of the government of the Kirov region of 20.12.2011 No. 133/697. (in Russ.).

14. Price list of the company “PROTEK” from 12.05.2012 (in Russ.).

15. Martsevich S. Yu., Navasardyan A. R., Kutishenko N. P. Experience in the study of atrial fibrillation on the basis of the PROFILE registry. Cardiovascular therapy and prevention (in Russ.). 2014; 2: 35-39.

16. Nieuwlaat R., Capucci A., Camm J. et al. Atrial fibrillation management: a prospective survey in ESC Member Countries. The Euro Heart Survey on Atrial Fibrillation. Eur Heart J. 2005; 26: 2422-2434.

17. Chugh S.S., Havmoeller R., Narayanan K. et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of disease 2010 Study. Circulation. 2014; 129 (8): 837-847.

18. Lukyanov M.M., Fighters S.A., Yakushin S.S. Diagnosis, treatment, combined cardiovascular disease and concomitant diseases in patients with a diagnosis of “atrial fibrillation” in real outpatient practice (according to the register of cardiovascular diseases of the REQUASE). Rational Pharmacotherapy in Cardiology (in Russ.). 2014; 10 (4): 366-377.

19. Gafarov D.A., Kokoshvili D.Z. Evaluation of the Charlson comorbidity index in patients with atrial fibrillation depending on age. Under edited by G.Yu. Gulyaev. CNS “Science and Education” (in Russ.). 2017; 328-330.

20. Efremova E. V., Shutov, A. M., Borodulina E. O. the Problem of comorbidity in chronic heart failure. Ulyanovsk medico-biological journal (in Russ.). 2015; 4: 46-52.

21. Wolowacz S.E. Samuel M., Brennan V.K. et al. The cost of illness of atrial fibrillation: a systematic review of the recent literature. Europace. 2011; 13(10): 1375-85.

22. Spyra A., Daniel D., Thate-Waschke I.M. et al. Atrial fibrillation in Germany: A prospective cost of illness study. Dtsch Med Wochenschr. 2015; 140(14):e142-8.

23. Turakhia M.P., Shafrin J., Bognar K. et al. Economic Burden of Undiagnosed Nonvalvular Atrial Fibrillation in the United States. Am J Cardiol. 2015; 116(5): 733-739.

24. Wodchis W.P., Bhatia R.S., Leblanc K. et al. A review of the cost of atrial fibrillation. Value Health. 2012; 15(2): P.240-248.

25. Kalashnikov V. Yu., Sereda E. G., Glezer M. G., Syrkin A. L. Clinical and economic analysis of the treatment of patients older than 65 years with relapsing atrial fibrillation. Problems of standardization in health care Value Health (in Russ.). 2007; 2: 47-53.

26. Kolbin A. S., Tatar B. A., Biserova I. N. et al. Socio-economic burden of atrial fibrillation in the Russian Federation. Clinical pharmacology and therapy (in Russ.). 2010; 19 (4): 17-22.


For citations:

Malchikova  S.V., Maksimchuk-Kolobova N.S., Kazakovtseva  M.V. Comorbidity in elderly patients with atrial fibrillation affects the “cost of illness”. FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology. 2019;12(3):191-199. (In Russ.)

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