Sen. Bill Frist, MD, FACS, hosted a workshop in Nashville on June 9 to highlight atrial fibrillation. “AFib in America: Spotlight on Tennessee: The Cost and Consequences of a Leading Cardiovascular Condition” underscored the toll … both physical and monetary … that missed or improper AFib diagnoses have on the state and nation.

Calling AFib a “complex, poorly recognized, fairly simple to diagnose once you look for it, and very simple to treat” condition, Frist explained the cardiovascular malady occurs when the upper chambers of the heart beat in an uncoordinated and disorganized fashion, resulting in a very irregular rhythm. When the atria quiver rather than beat effectively, blood isn’t pumped out of the upper chambers and can pool and clot, which can then lead to stroke. In fact, according to the American Heart Association, approximately 15 percent of strokes occur in those with AFib. The condition, which worsens over time if left untreated, also complicates the management of other cardiovascular diseases.

Frist said AFib effects as many as 2.5 million Americans every year, and the incidence rate is expected to double by the year 2040. He added about 80 percent of AFib cases occur after age 65 and become increasingly prevalent with each additional five years of age. “It remains today … in spite of that incidence … a largely unrecognized cost driver, and that impact will just increase over time so it’s one that we clearly need to address,” he explained.

Frist continued, “It has not been prominent on the public health agenda in the past, which is one of the reasons I’m involved.” Founder of the Vanderbilt Transplant Center and former U.S. Senate Majority, the nationally recognized heart and lung transplant surgeon said he wants to use his voice to go where problems need to be identified and acted upon to improve the quality of life for Tennesseans now that he has left the political arena.

During the recent Nashville event, Frist addressed the larger impact of chronic disease, saying, “Healthcare cost is a big issue. The greatness of America is determined on our debt. Our debt is driven by entitlements. Entitlements are driven by Medicare. Medicare is driven by costs. The cost drivers today are what we’re here to talk about.”

Frist began working on AFib awareness nearly three years ago through a program funded by Sanofi Aventis. The AF Stat™ initiative (www.AFStat.com) has broad support from 30 national partners including the major physician, nursing and hospital associations. Frist noted that AFib is a perfect example of the type of cost driver that could be significantly lessened with prevention, early diagnosis and early treatment.

In Tennessee, Frist said, recently released statistics showed 61,000 Medicare beneficiaries used healthcare services primarily due to AFib. “Tennessee’s total Medicare payments for the physician … not the hospital but the physician encounters … was $17.5 million in 2007, the last year data is available,” he said. Frist added, the average stay for those admitted due to AFib was four days. “And if you look at Medicare payments for hospitalizations due to AFib, for Tennessee it’s $26.3 million.”

“That’s the sort of thing people don’t know … policymakers don’t know,” he said of the more than $40 million being spent annually in Tennessee on a condition that could be prevented or managed at a much lower cost. “It is a good example of a chronic disease that is today improperly diagnosed and improperly treated that can be addressed if we just shine a light on it,” he stated. Furthermore, Frist continued, evidence-based medicine exists that would not only drive down costs but would also result in better outcomes for patients.

“Healthcare today is the single largest part of our budget. It’s important to look at cost drivers that eat away budgets. The more you spend on health, the less the government can spend on education,” he pointed out. As for having the type of discussion that occurred during the June workshop on AFib … and that will be part of Gov. Bill Haslam’s new Task Force on Health and Wellness led by John Lacey, MD … Frist said such conversations are valuable because, “It gets people out of their silos.”

AFib, he continued, is but one place where evidence-based, cost effective, high value therapy could be applied to the benefit of both patient and payers. He readily acknowledged it was a big task to educate physicians, patients and politicians about best practices and preventive measures and to get the groups to act upon that information consistently, but Frist said he believes it is a ‘doable’ task.

“These are all levers that can be pulled,” he concluded. “These are not problems that can’t be solved, I promise.”

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