PO-686-07 THE USE OF CHANGE-FROM-BASELINE DETECTION OF AF BURDEN TO PREDICT HEALTH CARE UTILIZATION IN PATIENTS WITH ATRIAL FIBRILLATION

Atrial fibrillation (AF) is associated with increased risk of healthcare utilization (HCU), which may be triggered by onset of AF or change in burden. Change from baseline of AF burden or other parameters measured by insertable cardiac monitors (ICM) may be useful to predict near-term (HCU). To determine whether rules-based algorithms that examine change from baseline of ICM parameters can be used to stratify risk of near-term HCU. We performed a retrospective cohort study of US patients with Medtronic ICMs enrolled in Carelink® remote monitoring (2007-2019) linked to medical claims data (Optum© Clinformatics database). The ICM cohort was matched to claims data with 7 encrypted identifiers. We included matched patients with ≥1 day of ICM detected AF (any quantity) and ≥12 months continuous enrollment pre- and post-ICM implant. AF burden (total hours/day of AT/AF) was transformed into simple moving averages (SMAs) of different periods (1, 2, 3, 5, 8, 13, 21 days) for each follow-up (FU), including a cumulative SMA calculated for the time between ICM implantation and FU. AF pattern was defined as the comparison of an SMA period with its cumulative average. The same process was applied to daily activity recorded by the ICM. HCU was defined as any encounter from a hospital, emergency room, or ambulatory surgical center with a cardiovascular DRG or diagnosis code. Classification trees were used to describe which ICM detected patterns best stratified patient risk of HCU. Of 89,578 ICM patients, 2,616 (2.9%) met AF and other inclusion criteria (71±11 years, 55% male, CHA2DS2-VASc 3.7±1.9). Overall, 1,998 (76%) had a HCU over 605,363 days. Burden pattern revealed distinct groups: (A) no history of AF (reference); (B) below average burden; (C) above average burden; (D) above average burden with low level ICM-detected daily activity. Odds of HCU were increased in all groups vs reference (B vs A OR 3.82; C vs A OR 8.25; D vs A OR 11.66), including a 33% increase in HCU detection over nominal duration & quantity thresholds. Change-from-baseline analyses of ICM-detected AF and ICM-detected daily activity was strongly associated with near-term HCU, especially high burden coupled with low activity. This approach could provide actionable information to guide treatment and reduce HCU.