Abstract 4145947: New Perspective on Guideline-Based Management of Atrial Fibrillation According to Socioeconomic Disparity

Background: As the global incidence of atrial fibrillation (AF) increases, the importance of implementing GDMT (Guideline-Directed Medical Therapy) for managing AF is being emphasized. Research Questions: Applying guidelines universally across all countries and situations is realistically challenging. Aims: Identifying the appropriate income level for GDMT and highlighting the need for new standards. Methods: Based on data from the Global Burden of Disease 2021 and provided by WHO and the World Bank, information from 186 countries was analyzed. GDP was based on 2021 United states dollar (USD), and the average cost of AF treatment was analyzed in correlation with GDP and OOPs (Out-of-pocket Expenses) across four income groups. The percentage of the average cost paid by an individual for AF out of total OOPs was calculated as (Estimated patient payment based on previous studies x prevalence) x 100 / OOPs. Results: Among the 186 countries, the average GDPs of 58 HICs (High-Income Countries), 52 UMICs (Upper Middle-Income Countries), 54 LMICs (Lower Middle-Income Countries), and 22 LICs (Low-Income Countries) were studied. The prevalence of AF in HICs, UMICs, and LMICs showed a trend of increasing with income level, with age-standardized rates per 100,000 being 645.6 ± 164.0, 613.9 ± 100.3, and 528.3 ± 105.7 respectively. However, the rate of AF-related deaths was 5.6 ± 1.7, 5.5 ± 2.0, and 4.6 ± 1.3 (age-standardized rates per 100,000) respectively, with the proportion of AF deaths relative to prevalence being highest in UMICs, and higher in LMICs compared to HICs. In terms of rhythm control strategy, the specific cost of catheter ablation (22,143.5, by 2021USD) was affordable primarily in HICs, and the majority of LMICs showed a GDP lower than the AAD-only specific cost (7,622.7 by 2020USD), indicating economic barriers to GDMT for AF. The proportion of AF cost in OOPs showed a tendency to increase as the income level decreased. Conclusion: In the AF management, catheter ablation is considered viable only for a very small part of UMICs and primarily for HICs. In LMICs and most UMICs, the importance of medication-based therapy is highlighted, suggesting the need to establish new guidelines according to socioeconomic status.